Decreased intravesical adenosine triphosphate in patients with refractory detrusor overactivity and bacteriuria.

PURPOSE: Although several studies have examined the relationship between adenosine triphosphate release from the urothelium and bladder sensations including painful filling and urgency, the association between bacteriuria and urothelial adenosine triphosphate release has not been well studied. We evaluated women with refractory detrusor overactivity who were experiencing an acute exacerbation of detrusor overactivity symptoms including frequency, urgency and nocturia (and/or urge incontinence). We measured changes in intravesical adenosine triphosphate levels in these women with and without bacteriuria. MATERIALS AND METHODS: In this prospective cohort study women with refractory detrusor overactivity were invited to our unit during acute symptomatic exacerbation. On presentation a catheter urine specimen was collected and 50 ml normal saline instilled into the bladder to evoke gentle stretch, with removal after 5 minutes. Adenosine triphosphate concentrations were determined on fresh washings using a bioluminescence assay. RESULTS: The incidence of bacteriuria 10(3) cfu/ml or greater was 27% (15 of 56 specimens) during the 16-month study period. Adenosine triphosphate concentrations were lower during episodes of bacteriuria in the overall cohort (p = 0.0013) and paired samples from individual patients (p = 0.031) compared to episodes of sterile urine. CONCLUSIONS: In the first study on the subject to our knowledge, we demonstrated a striking difference between adenosine triphosphate levels measured in the presence and absence of bacteriuria in this patient group.

Asymptomatic bacteriuria among the elderly residents of long-term care facilities in Taiwan.

BACKGROUND: asymptomatic bacteriuria (ASB) is common among the institutionalised elderly (IE). The cytokine levels and factors associated with ASB are unknown. OBJECTIVE: to analyse cytokines and factors associated with ASB among the IE living in long-term care facilities (LTCFs) in Taiwan. METHODS: this case-control study included residents ≥65 years in two LTCFs. The demographics, functional status, serum and urine levels of cytokines and proteins were compared between IE with ASB and those with sterile urine. Logistic regression was used to determine the factors associated with ASB. RESULTS: the IE with ASB had elevated IL-8 in blood and urine compared with the IE with sterile urine. The Barthel index score, serum creatinine, blood IL-8 and tumour necrosis factor-α levels were significant factors associated with ASB among the IE [odds ratio (OR) 0.957, 95% CI: 0.936-0.979, P < 0.0001; OR: 0.264, 95% CI: 0.076-0.912, P = 0.035 and OR: 1.088, 95% CI: 1.022-1.158, P = 0.009; OR: 0.828, 95% CI: 0.711-0.965, P = 0.016, respectively). CONCLUSION: functional status, renal function and blood cytokine levels were factors significantly associated with ASB among the IE living in Taiwan.

Comparison of Escherichia coli uropathogenic genes (kps, usp and ireA) and enteroaggregative genes (aggR and aap) via multiplex polymerase chain reaction from suprapubic urine specimens of young children with fever.

OBJECTIVE: Escherichia coli is the most frequently identified microbiological agent in childhood urinary tract infections (UTIs). However, the pathogenic role of this organism in young children remains to be clearly elucidated. So far, no studies have been conducted in which multiplex polymerase chain reaction (PCR) has been applied to determine the association between childhood UTIs and E. coli and urovirulent genes. MATERIAL AND METHODS: Altogether, 330 suprapubic urine specimens from febrile young children were cultured. In 33 of the cases, E. coli was identified; among these cases, 18 had a UTI (>10(4)-10(5) cfu/ml), four had a suspected UTI (>10(2)-10(3) cfu/ml) and 11 did not have UTIs (10(2) cfu/ml). Using multiplex PCR, three uropathogenic E. coli (UPEC) genes and two enteroaggregative E. coli (EAEC) genes were detected. RESULTS: In the UTI-UPEC cases, the kps gene was detected in 18 of 22 cases (82%) and the usp gene in 16 of 22 cases (73%). Among the 18 cases of children with UTIs characterized by 10(4)-10(5) E. coli cfu/ml, urinary tract abnormalities were identified via dimercaptosuccinic acid scans in seven of 18 cases (39%) and via voiding cystourethrograms in four of the 18 cases (22%). CONCLUSIONS: The UPEC kps and usp genes were clearly associated with childhood UTIs, and may also be associated with kidney or urinary tract dysfunctions in young children. Escherichia coli colony count numbers in excess of 10(4)-10(5) cfu/ml in the suprapubic urine were considered to be strong evidence of UTI in infants.

Bacteriuria detection with a urine dipstick applied to incontinence pads of nursing home residents.

The purpose of this study was to evaluate a new method of initial on-site evaluation of bacteriuria in an incontinent nursing home population. Nitrite and a composite of nitrite and/or leukocyte esterase results of the new method were compared with clean-catch urine culture results of each participant to determine sensitivity, specificity, positive and negative predictive values, and efficiency. These findings were compared with results of the traditional dipstick urinalysis for bacteriuria assessment. The new method was as effective as the traditional method in assessing both the presence and absence of bacteriuria. Results of this study indicate the new dipstick/pad method may assist in the assessment of bacteriuria in incontinent nursing home residents.

Visualization of Proteus mirabilis within the matrix of urease-induced bladder stones during experimental urinary tract infection.

The virulence of a urease-negative mutant of uropathogenic Proteus mirabilis and its wild-type parent strain was assessed by using a CBA mouse model of catheterized urinary tract infection. Overall, catheterized mice were significantly more susceptible than uncatheterized mice to infection by wild-type P. mirabilis. At a high inoculum, the urease-negative mutant successfully colonized bladders of catheterized mice but did not cause urolithiasis and was still severely attenuated in its ability to ascend to kidneys. Using confocal laser scanning microscopy and scanning electron microscopy, we demonstrated the presence of P. mirabilis within the urease-induced stone matrix. Alizarin red S staining was used to detect calcium-containing deposits in bladder and kidney tissues of P. mirabilis-infected mice.

Cytokine secretion is impaired in women with diabetes mellitus.

BACKGROUND: As women with diabetes mellitus (DM) have an increased prevalence of asymptomatic bacteriuria (ASB) and it is known that a correlation exists between the increased prevalence of genitourinary tract infection and impaired cytokine production in women infected with Human Immunodeficiency Virus (HIV), we studied urinary cytokine excretion in diabetic women and compared it with that of nondiabetic controls. MATERIALS AND METHODS: To evaluate the cytokine secretion capacity of women with DM, both whole blood and isolated monocytes of women with and without DM were stimulated in vitro with lipopolysaccharide (LPS). RESULTS: Lower urinary interleukin-8 (IL-8) and interleukin-6 (IL-6) concentrations (P = 0.1 and P < 0.001, respectively) were found in diabetic women than in nondiabetic controls. A lower urinary leukocyte cell count correlated with lower urinary IL-8 and IL-6 concentrations (P < 0.05). Lower tumour necrosis factor-alpha (TNF-alpha) and IL-6, but comparable interleukin-10 (IL-10) concentrations were found in whole blood (P < 0.04) and isolated monocytes (P = 0.03) of women with DM type 1 compared to women without DM. CONCLUSIONS: Diabetic women with ASB have lower urinary IL-6 concentrations than nondiabetic bacteriuric controls. In addition, monocytes of women with DM type 1 secrete lower pro-inflammatory cytokines after stimulation with LPS than monocytes of women without DM. This is not due to an inhibitory effect of the anti-inflammatory cytokine IL-10. This can have important consequences for both host defense, endothelial cell functioning and atherogenesis.

Interleukin (IL)-6 and IL-8 in children with febrile urinary tract infection and asymptomatic bacteriuria.

Urine and serum interleukin (IL)-6 and IL-8 responses were higher in children with febrile urinary tract infection (n = 61) than in those with asymptomatic bacteriuria (n = 39). By univariate analysis, cytokine levels were related to age, sex, reflux, renal scarring, urine leukocytes, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and bacterial properties (P fimbriae but not hemolysin). Multivariate modeling showed that urine IL-6 responses were higher in girls than boys, increased with age, and were positively associated with CRP, ESR, serum IL-6, and urine leukocyte counts. The urine IL-8 response was not influenced by age, but it was influenced by P fimbriae and was associated with ESR, CRP, urine leukocytes, and female sex. The results show that cytokine responses to urinary tract infection vary with the severity of infection and that cytokine activation is influenced by a variety of host and bacterial variables.

Urinary pH and urea concentration correlate to the bacterial colonization rate in gastric, colonic, ileal and myoperitoneal bladder augmentation.

We investigated how various types of augmentation cystoplasty alter the native bacteriostatic properties of urine, particularly urinary urea and pH, in the Sprague-Dawley rat. The augmentation cystoplasties studied included 1 cm.2 and 2 cm.2 patches of colon, ileum and stomach as well as myoperitoneal bladder flaps. Augmentations in order of decreasing incidence of bacteriuria and urinary pH are 2 cm.2 ileal greater than 1 cm.2 ileal greater than 2 cm.2 colonic greater than 1 cm.2 colonic greater than myoperitoneal greater than cystotomy alone greater than 1 cm.2 gastric greater than 2 cm.2 gastric. Urinary urea concentrations were similar between cystotomy alone, and myoperitoneal and gastric augments. In contrast, all colonic and ileal augments had significantly lower urea concentrations compared to the aforementioned groups. Our findings suggest that the type and size of augmentation directly affect urinary pH and urea nitrogen concentration, and the incidence of bacteriuria.

Absorption of doxorubicin-hydrochloride and mitomycin-C after instillation into noninfected and infected bladders of dogs.

The described investigations were carried out in order to determine the degree of absorption of doxorubicin, and mitomycin-C after intravesical instillation into noninfected or Staphylococcus aureus-infected bladders in beagle dogs. The drug concentrations in the bladder wall were determined using diffusion chambers with permeable membranes. Two hours after end of instillation of 10 mg. doxorubicin, a concentration of 1.4 ng. per ml. was measured in the bladder wall of noninfected animals, and 3.75 ng. per ml. in that of infected animals (p less than 0.05). The simultaneously measured serum concentration reached mean peak levels after 30 minutes. The concentrations in infected animals were 3 times higher (1.9 ng. per ml.) than in noninfected animals (0.6 ng. per ml.) (p less than 0.05). After instillation of 1 mg. per kg. bw. mitomycin-C the concentration in both groups of animals was below 0.06 micrograms per ml. Doxorubicin concentrations were determined with a radioimmunoassay and mitomycin-C with a micro-agar diffusion method.