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Urinary Tract Infection in Children
INFECTIONS AND ANTIBIOTICS
search Services, Veterans Administration Medical Center, Gainesville, Florida Amer. J. Med., 77: 362-364 (Aug.) 1984 The authors report on· a 67-year-old man with recurrent prostatic obstruction treated by transurethral resection. The pathological specimens revealed acute and chronic inflam mation, eosinophilic tissue infiltrates, a focus of vasculitis and granulomas. Staining and culture for fungi and mycobacteria were negative. There was no evidence of carcinoma, systemic vasculitis, asthma or allergies associated with the eosinophilic prostatitis. The patient was treated with 60 mg. prednisone daily with the dosage tapered to an alternate-day regimen for 9 months. Urethral obstruction has not recurred. F. T. A. 10 references
Hemophilus Influenzae as a Cause of Urinary Tract Infections in Men
T.
GAGRE-KIDAN, B. A. LIPSKY AND J. J. PLORDE, Medicine and Laboratory Services, American Lake Veterans Administration Medical Center, Tacoma, Washington, and Departments of Medicine and Laboratory Medicine, the University of Washington School of Medicine, Seattle, and Medical and Laboratory Services, Seattle VA Medical Center, Seattle, Washington
Arch. Intern. Med., 144: 1623-1627 (Aug.) 1984 Hemophilus influenzae was isolated from the urine of 8 men: 3 had acute cystitis, 2 had pyelonephritis, 2 had prostatitis and 1 had asymptomatic bacteriuria with pyuria. All urine specimens were inoculated on chocolate agar and yielded B-lactamase-negative Hemophilus influenzae. All organisms were nonserotypable and were of biotypes 2 to 4. Hemophilus influenzae recently has gained increased recognition as a cause of various infections in adults and also may be a more common cause of urinary tract infections than has been appreciated previously. F. T. A. 2 tables, 26 references
Detection of Bacteremia With the BACTEC 16B Resin Blood Culture Medium P.
C. DEGIROLAMI, K. EICHELBERGER AND J. SIEGEL, Department of Pathology, Microbiology Section, New England Deaconess Hospital, Boston, Massachusetts
Amer. J. Clin. Path., 81: 643-646 (May) 1984 The use of resins to bind unwanted compounds in vivo or in vitro has found applications in the laboratory (for example ion exchange chromatography) and to a lesser extent in clinical therapeutics. The first application of this principle to blood culture methods was the antimicrobial removal device (Marion Scientific, Kansas City, Missouri), which was designed to bind antimicrobials present in blood and, thus, enhance recovery of organisms. A new blood culture medium (16B) containing absorbent and cationic exchange resins has become available for use with the BACTEC instrument (Johnston Laboratories, Towson, Maryland). Its purpose is to enhance the detection of the bacteremia through binding of antimicrobials. The performance of the BACTEC 16B resin medium was compared to the routine BACTEC 6B medium in patients with suspected sepsis receiving antibiotics. Of 1,227 blood specimens inoculated in 6B and
149
16B media 93 from 43 clinically septic patients yielded positive cultures. Of 103 bacterial isolates recovered 63 (61.2 per cent) were from both media, 14 (13.6 per cent) from the routine 6B medium only and 26 (25.2 per cent) from the resin medium only (p >0.05). Coagulase positive and negative staphylococci were recovered much more frequently from resin medium (p <0.01). When the results of all blood culture sets collected for each patient on any given day were considered, the routine 6B medium was the only source of isolation for 7 bacterial species in 6 patients, and the resin medium was the only source of isolation for 9 species in 9 patients. However, of the latter 9 organisms 8 were recovered early in the course of antibiotic therapy (6 within 24 to 36 hours and 2 within 36 to 48 hours of the first antibiotic dose) and had been isolated previously in routine 6B medium. In no instance was the antibiotic regimen changed as a result of persistence of the organism in resin medium in the early phases of treatment. The use of resin medium did not improve over-all detection time for 63 isolates recovered from both media. In conclusion, although the 16B resin medium did recover a greater number of bacterial isolates little information was contributed that might be useful in modifying and improving the treatment of septic patients receiving antimicrobials. W. W. H. 2 tables, 17 references
Urinary Tract Infection In Children
w. MCKERROW, N. DAVIDSON-LAMB AND P. F. JONES,
Royal
Aberdeen Children's Hospital, Aberdeen, Great Britain Brit. Med. J., 289: 299-303 (Aug. 4) 1984 From 1968 through 1977, 572 consecutive children less than 13 years old with a history of at least 1 confirmed urinary tract infection were investigated. Excretory urography, voiding cystourethrography and cystoscopy were performed at initial presentation. Radionuclide scanning also was done when indicated. The younger the child the greater the chance of finding an abnormality. Positive findings and the need for operation were greater in children after 1 episode of urinary tract infection than in those with recurrent infection. Of the children 48 per cent had cystourethritis, 31 per cent had vesicoureteral reflux, and the remainder had scarred kidneys, agenesis, duplex and polycystic kidneys, and obstruction. Followup ranged from 5 to 15 years. All patients with cystourethritis were followed until they had been asymptomatic and free of infection for about 1 year. All children with reflux and those who required an operation were followed indefinitely. There were few late complications. Nearly half of the patients with a positive culture will have an appreciable abnormality. The importance of culturing the urine after the first proved urinary infection is emphasized. F.T.A. 4 figures, 4 tables, 18 references
Comparison of Reliability of Tests to Distinguish Upper From Lower Urinary Tract Infection G. H. C. SCHARDIJN, L. w. STATIUS VANEPS, w. PAUW, C. HOEFNAGEL AND W. J. NOOYEN, Slotervaart Hospital and
Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Brit. Med. J., 289: 284-287 (Aug. 4) 1984 The results of scintiphotography with 67 gallium (67 Ga), renography with 99 tntechnetium-diethylenetriaminepentaacetic
search Services, Veterans Administration Medical Center, Gainesville, Florida Amer. J. Med., 77: 362-364 (Aug.) 1984 The authors report on· a 67-year-old man with recurrent prostatic obstruction treated by transurethral resection. The pathological specimens revealed acute and chronic inflam mation, eosinophilic tissue infiltrates, a focus of vasculitis and granulomas. Staining and culture for fungi and mycobacteria were negative. There was no evidence of carcinoma, systemic vasculitis, asthma or allergies associated with the eosinophilic prostatitis. The patient was treated with 60 mg. prednisone daily with the dosage tapered to an alternate-day regimen for 9 months. Urethral obstruction has not recurred. F. T. A. 10 references
Hemophilus Influenzae as a Cause of Urinary Tract Infections in Men
T.
GAGRE-KIDAN, B. A. LIPSKY AND J. J. PLORDE, Medicine and Laboratory Services, American Lake Veterans Administration Medical Center, Tacoma, Washington, and Departments of Medicine and Laboratory Medicine, the University of Washington School of Medicine, Seattle, and Medical and Laboratory Services, Seattle VA Medical Center, Seattle, Washington
Arch. Intern. Med., 144: 1623-1627 (Aug.) 1984 Hemophilus influenzae was isolated from the urine of 8 men: 3 had acute cystitis, 2 had pyelonephritis, 2 had prostatitis and 1 had asymptomatic bacteriuria with pyuria. All urine specimens were inoculated on chocolate agar and yielded B-lactamase-negative Hemophilus influenzae. All organisms were nonserotypable and were of biotypes 2 to 4. Hemophilus influenzae recently has gained increased recognition as a cause of various infections in adults and also may be a more common cause of urinary tract infections than has been appreciated previously. F. T. A. 2 tables, 26 references
Detection of Bacteremia With the BACTEC 16B Resin Blood Culture Medium P.
C. DEGIROLAMI, K. EICHELBERGER AND J. SIEGEL, Department of Pathology, Microbiology Section, New England Deaconess Hospital, Boston, Massachusetts
Amer. J. Clin. Path., 81: 643-646 (May) 1984 The use of resins to bind unwanted compounds in vivo or in vitro has found applications in the laboratory (for example ion exchange chromatography) and to a lesser extent in clinical therapeutics. The first application of this principle to blood culture methods was the antimicrobial removal device (Marion Scientific, Kansas City, Missouri), which was designed to bind antimicrobials present in blood and, thus, enhance recovery of organisms. A new blood culture medium (16B) containing absorbent and cationic exchange resins has become available for use with the BACTEC instrument (Johnston Laboratories, Towson, Maryland). Its purpose is to enhance the detection of the bacteremia through binding of antimicrobials. The performance of the BACTEC 16B resin medium was compared to the routine BACTEC 6B medium in patients with suspected sepsis receiving antibiotics. Of 1,227 blood specimens inoculated in 6B and
149
16B media 93 from 43 clinically septic patients yielded positive cultures. Of 103 bacterial isolates recovered 63 (61.2 per cent) were from both media, 14 (13.6 per cent) from the routine 6B medium only and 26 (25.2 per cent) from the resin medium only (p >0.05). Coagulase positive and negative staphylococci were recovered much more frequently from resin medium (p <0.01). When the results of all blood culture sets collected for each patient on any given day were considered, the routine 6B medium was the only source of isolation for 7 bacterial species in 6 patients, and the resin medium was the only source of isolation for 9 species in 9 patients. However, of the latter 9 organisms 8 were recovered early in the course of antibiotic therapy (6 within 24 to 36 hours and 2 within 36 to 48 hours of the first antibiotic dose) and had been isolated previously in routine 6B medium. In no instance was the antibiotic regimen changed as a result of persistence of the organism in resin medium in the early phases of treatment. The use of resin medium did not improve over-all detection time for 63 isolates recovered from both media. In conclusion, although the 16B resin medium did recover a greater number of bacterial isolates little information was contributed that might be useful in modifying and improving the treatment of septic patients receiving antimicrobials. W. W. H. 2 tables, 17 references
Urinary Tract Infection In Children
w. MCKERROW, N. DAVIDSON-LAMB AND P. F. JONES,
Royal
Aberdeen Children's Hospital, Aberdeen, Great Britain Brit. Med. J., 289: 299-303 (Aug. 4) 1984 From 1968 through 1977, 572 consecutive children less than 13 years old with a history of at least 1 confirmed urinary tract infection were investigated. Excretory urography, voiding cystourethrography and cystoscopy were performed at initial presentation. Radionuclide scanning also was done when indicated. The younger the child the greater the chance of finding an abnormality. Positive findings and the need for operation were greater in children after 1 episode of urinary tract infection than in those with recurrent infection. Of the children 48 per cent had cystourethritis, 31 per cent had vesicoureteral reflux, and the remainder had scarred kidneys, agenesis, duplex and polycystic kidneys, and obstruction. Followup ranged from 5 to 15 years. All patients with cystourethritis were followed until they had been asymptomatic and free of infection for about 1 year. All children with reflux and those who required an operation were followed indefinitely. There were few late complications. Nearly half of the patients with a positive culture will have an appreciable abnormality. The importance of culturing the urine after the first proved urinary infection is emphasized. F.T.A. 4 figures, 4 tables, 18 references
Comparison of Reliability of Tests to Distinguish Upper From Lower Urinary Tract Infection G. H. C. SCHARDIJN, L. w. STATIUS VANEPS, w. PAUW, C. HOEFNAGEL AND W. J. NOOYEN, Slotervaart Hospital and
Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Brit. Med. J., 289: 284-287 (Aug. 4) 1984 The results of scintiphotography with 67 gallium (67 Ga), renography with 99 tntechnetium-diethylenetriaminepentaacetic