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Clinical Importance of “Breakthrough” Bacteremia
0022-534 7/84/1321-0191$02.00/0 Vol. 132, July
THE JOURNAL OF UROLOGY
Copyright© 1984 by The Williams & Wilkins Co.
Printed in U.S.A.
ABSTRACTS INFECTIONS AND ANTIBIOTICS Catheter-Associated Bacteriuria: Failure to Reduce Attack Rates Using Periodic Instillations of a Disinfectant Into Urinary Drainage Systems R. L. THOMPSON, C. E. HALEY, M. A. SEARCY, s. M. GUENTHNER, D. L. KAISER, D. H. M. GROSCHEL, J. Y. GILLENWATER AND R. P. WENZEL, Departments of Medicine, Pathology and Urology, School of Medicine and Department of Epidemiology, Graduate School of Arts and Sciences, University of Virginia, Charlottesville, Virginia J.A.M.A., 251: 747-751 (Feb. 10) 1984
The Bac-T-Screen method seems to be more sensitive than other automated systems of bacterial quantitation. The authors found a low level of specificity, which was attributed to the fact that the Bac-T-Screen method will detect low levels of bacteria in the specimens. The authors concluded that the method is quick, efficient and reliable, and they believe that it has a definite role as a screening test to identify urine specimens that are negative. G. F. S. 3 tables, 23 references
Clinical Importance of "Breakthrough" Bacteremia
M. P.
· The efficacy of periodic instillations of hydrogen peroxide into urinary drainage systems for the prevention of catheterassociated bacteriuria was assessed in a prospective, randomized clinical study of 688 patients with indwelling urethral catheters. Bacteriuria was documented in 68 of the 688 patients (10 per cent) after a mean of 4 days on catheterization. There was no difference between the hydrogen peroxide and the control groups in the mean duration of catheterization before the onset of bacteriuria, attack rate for bacteriuria or spectrum of etiologic agents recovered. Bag contamination with the same organism responsible for bacteriuria preceded infection in only 5 of the 68 patients (7 per cent): 3 in the hydrogen peroxide and 2 in the control groups. We conclude that infections arising intraluminally from contamination of the drainage bag are uncommon among catheterized patients and that periodic instillation of disinfectants into closed sterile drainage systems is not effective in reducing the incidence of catheter-associated bacteriuria. Authors' abstract 1 figure, 3 tables, 20 references
Clinical Laboratory Evaluation of a Bacteriuria Detection Device for Urine Screening J. R. DAVIS, C. E. STAGER AND G. F. ARAJ, The Methodist Hospital, Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas Amer. J. Clin. Path., 81: 48-53 (Jan.) 1984 The ability of the Bac-T-Screen method to identify urine specimens containing bacteria at concentrations > 104 and> 105 colony-forming units per ml. was tested by comparison with routine culture techniques. The Bac-T-Screen method relies on the principle that bacteria are stained easily with safranin dye and that the degree of staining is related directly to the numbers of bacteria present in a given urine specimen. The system is fully automated, requires only 1 cc urine and takes only 2½ minutes to complete. Of 1,609 urine specimens 148 (9.2 per cent) could not be interpreted with the Bac-T-Screen system because of clogging of the filter in the machine or because of pigment in the urine that gave an equivocal result. Of the 271 specimens with> 105 colony-forming units per ml. on routine culture techniques the Bac-T-Screen system identified correctly 264 (97.4 per cent), compared to 82 of 109 specimens (75 per cent) with 104 to 105 colony-forming units per ml. on routine testing.
WEINSTEIN AND L. B. RELLER, Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
Amer. J. Med., 76: 175-180 (Feb.) 1984 The authors report 51 episodes of breakthrough bacteremia and 1 of fungemia among 40 patients. Of these episodes 41 occurred in patients receiving parenteral antimicrobials, while 11 occurred in patients receiving oral agents. Patients with breakthrough bacteremia had significantly more facultative and aerobic gram-negative rods (for example Enterobacteriaceae and Pseudomonas species) than anaerobes. Breakthrough bacteremia is more likely to occur in patients with predisposing factors, such as immunosuppressive doses of glucocorticosteroids, diabetes mellitus, moderate renal failure and liver transplants. Intra-abdominal foci (abscesses, and biliary tract and bowel infections) are the primary sources of infection, comprising 33 per cent of all episodes of breakthrough bacteremia compared to 13 per cent of all nonbreakthrough infections. The over-all mortality rate in patients with breakthrough bacteremia was 61 per cent compared to 40 per cent for those with nonbreakthrough infections. The increased frequency with which gram-negative rods caused breakthrough bacteremia supports indirectly the previous reports that subinhibitory levels of antimicrobials may have a role in the occurrence of breakthrough infections. The phenomenon of breakthrough bacteremia shows the potential limitations of antimicrobial therapy alone, especially with single agents, such as aminoglycosides, which have narrow therapeutic margins. The role of blood culture methods that use resin removal of antibiotics to enable earlier detection of breakthrough bacteremia and improved therapy needs further investigation. F. T. A. 4 tables, 27 references
Significance of Microhaematuria in Young Adults
P.
FROOM, J. RIBAK AND J. BENBASSAT, Israel Air Force Aeromedical Center, Tel Hashomer, Israel and Department of Medicine, Hadassah University Hospital at Mount Scopus, Jerusalem, Israel
Brit. Med. J., 288: 20-22 (Jan. 7) 1984 There is general agreement that asymptomatic isolated microhematuria in adults warrants urological investigation, including excretory urography (IVP) and cystoscopy. Serious urological lesions have been reported in 5, 20, 14.2 and 11 per cent of patients referred for microhematuria. Therefore, it has 191
THE JOURNAL OF UROLOGY
Copyright© 1984 by The Williams & Wilkins Co.
Printed in U.S.A.
ABSTRACTS INFECTIONS AND ANTIBIOTICS Catheter-Associated Bacteriuria: Failure to Reduce Attack Rates Using Periodic Instillations of a Disinfectant Into Urinary Drainage Systems R. L. THOMPSON, C. E. HALEY, M. A. SEARCY, s. M. GUENTHNER, D. L. KAISER, D. H. M. GROSCHEL, J. Y. GILLENWATER AND R. P. WENZEL, Departments of Medicine, Pathology and Urology, School of Medicine and Department of Epidemiology, Graduate School of Arts and Sciences, University of Virginia, Charlottesville, Virginia J.A.M.A., 251: 747-751 (Feb. 10) 1984
The Bac-T-Screen method seems to be more sensitive than other automated systems of bacterial quantitation. The authors found a low level of specificity, which was attributed to the fact that the Bac-T-Screen method will detect low levels of bacteria in the specimens. The authors concluded that the method is quick, efficient and reliable, and they believe that it has a definite role as a screening test to identify urine specimens that are negative. G. F. S. 3 tables, 23 references
Clinical Importance of "Breakthrough" Bacteremia
M. P.
· The efficacy of periodic instillations of hydrogen peroxide into urinary drainage systems for the prevention of catheterassociated bacteriuria was assessed in a prospective, randomized clinical study of 688 patients with indwelling urethral catheters. Bacteriuria was documented in 68 of the 688 patients (10 per cent) after a mean of 4 days on catheterization. There was no difference between the hydrogen peroxide and the control groups in the mean duration of catheterization before the onset of bacteriuria, attack rate for bacteriuria or spectrum of etiologic agents recovered. Bag contamination with the same organism responsible for bacteriuria preceded infection in only 5 of the 68 patients (7 per cent): 3 in the hydrogen peroxide and 2 in the control groups. We conclude that infections arising intraluminally from contamination of the drainage bag are uncommon among catheterized patients and that periodic instillation of disinfectants into closed sterile drainage systems is not effective in reducing the incidence of catheter-associated bacteriuria. Authors' abstract 1 figure, 3 tables, 20 references
Clinical Laboratory Evaluation of a Bacteriuria Detection Device for Urine Screening J. R. DAVIS, C. E. STAGER AND G. F. ARAJ, The Methodist Hospital, Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas Amer. J. Clin. Path., 81: 48-53 (Jan.) 1984 The ability of the Bac-T-Screen method to identify urine specimens containing bacteria at concentrations > 104 and> 105 colony-forming units per ml. was tested by comparison with routine culture techniques. The Bac-T-Screen method relies on the principle that bacteria are stained easily with safranin dye and that the degree of staining is related directly to the numbers of bacteria present in a given urine specimen. The system is fully automated, requires only 1 cc urine and takes only 2½ minutes to complete. Of 1,609 urine specimens 148 (9.2 per cent) could not be interpreted with the Bac-T-Screen system because of clogging of the filter in the machine or because of pigment in the urine that gave an equivocal result. Of the 271 specimens with> 105 colony-forming units per ml. on routine culture techniques the Bac-T-Screen system identified correctly 264 (97.4 per cent), compared to 82 of 109 specimens (75 per cent) with 104 to 105 colony-forming units per ml. on routine testing.
WEINSTEIN AND L. B. RELLER, Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
Amer. J. Med., 76: 175-180 (Feb.) 1984 The authors report 51 episodes of breakthrough bacteremia and 1 of fungemia among 40 patients. Of these episodes 41 occurred in patients receiving parenteral antimicrobials, while 11 occurred in patients receiving oral agents. Patients with breakthrough bacteremia had significantly more facultative and aerobic gram-negative rods (for example Enterobacteriaceae and Pseudomonas species) than anaerobes. Breakthrough bacteremia is more likely to occur in patients with predisposing factors, such as immunosuppressive doses of glucocorticosteroids, diabetes mellitus, moderate renal failure and liver transplants. Intra-abdominal foci (abscesses, and biliary tract and bowel infections) are the primary sources of infection, comprising 33 per cent of all episodes of breakthrough bacteremia compared to 13 per cent of all nonbreakthrough infections. The over-all mortality rate in patients with breakthrough bacteremia was 61 per cent compared to 40 per cent for those with nonbreakthrough infections. The increased frequency with which gram-negative rods caused breakthrough bacteremia supports indirectly the previous reports that subinhibitory levels of antimicrobials may have a role in the occurrence of breakthrough infections. The phenomenon of breakthrough bacteremia shows the potential limitations of antimicrobial therapy alone, especially with single agents, such as aminoglycosides, which have narrow therapeutic margins. The role of blood culture methods that use resin removal of antibiotics to enable earlier detection of breakthrough bacteremia and improved therapy needs further investigation. F. T. A. 4 tables, 27 references
Significance of Microhaematuria in Young Adults
P.
FROOM, J. RIBAK AND J. BENBASSAT, Israel Air Force Aeromedical Center, Tel Hashomer, Israel and Department of Medicine, Hadassah University Hospital at Mount Scopus, Jerusalem, Israel
Brit. Med. J., 288: 20-22 (Jan. 7) 1984 There is general agreement that asymptomatic isolated microhematuria in adults warrants urological investigation, including excretory urography (IVP) and cystoscopy. Serious urological lesions have been reported in 5, 20, 14.2 and 11 per cent of patients referred for microhematuria. Therefore, it has 191