[Fluconazole in treatment of urinary candidiasis. Experience with 24 patients]. / Fluconazol en el tratamiento de la candidiasis urinaria. Experiencia en 24 pacientes.

Since fluconazole achieves high urine concentrations, we assessed its usefulness in the treatment of urinary candidiasis. We studied 24 patients (8 male) aged 23 to 97 years old, that presented pyuria with a negative urine culture for bacteria and fungal colony counts in urine of 10(4) CFU/ml or more. Isolated strains were Candida albicans in 20 cases, Candida kefyr in one case, Candida glabrata in one case and Candida spp in two cases. All patients were treated with fluconazole in doses of 50 to 100 mg/day for 2 to 4 weeks. The fungus was eradicated in 21 patients (88%), the infection persisted in two (8.5%) and one had a relapse (4.2%). Two patients had transient elevations of transaminases, one had abdominal pain and one, a purpuric syndrome without thrombocytopenia in whom the drug was discontinued. It is concluded that fluconazole is efficacious and safe in the treatment of urinary candidiasis.

Bacteriuria in children with neurogenic bladder treated with intermittent catheterization: natural history.

OBJECTIVE: To determine whether bacteriuria unassociated with symptoms in patients with neurogenic bladder will lead to symptomatic infection and/or deterioration of the upper urinary tract if left untreated, we examined whether bacteriuria persisted in bladder urine of children with neurogenic bladder treated with clean intermittent catheterization (CIC) and whether persistence of bacteria led to symptomatic infection or deterioration of the upper urinary tract. DESIGN: Weekly home visits were made during 6 months of surveillance of 14 children on the CIC regimen with a normal upper urinary tract and no reflux (as determined by renal ultrasonography, voiding cystourethrography, and serum creatinine measurement). During visits a sample of bladder urine was obtained by CIC, and signs and symptoms of urinary tract infection and all medications were recorded. RESULTS: Fourteen children were observed for 323 weeks. Cultures of 70% (172/244) of the urine samples collected were positive for organisms (> or = 10(4) colony-forming units per milliliter), 152 (88%) for the usual pathogens and 20 (12%) for commensal organisms. Bacteriuria was associated with pyuria two thirds of the time, regardless of bacterial species. Carriage of the same pathogen for 4 weeks or longer, with associated pyuria, was common during surveillance. Despite frequent episodes of bacteriuria with associated pyuria, there were only five symptomatic infections during the 323 patient-weeks. Children remained clinically well during the study period, and their upper urinary tract did not deteriorate. CONCLUSION: Bacteriuria persists for weeks in symptom-free children being treated with CIC for neurogenic bladder associated with a normal upper urinary tract. Before attempts are made to eradicate bacteriuria, treatment should be proved to be beneficial to this population.

Prevalence of urinary tract infection in febrile infants.

Urinary tract infection (UTI), a relatively common cause of fever in infancy, usually consists of pyelonephritis and may cause permanent renal damage. This study assessed (1) the prevalence of UTI in febrile infants (temperature > or = 38.3 degrees C) with differing demographic and clinical characteristics and (2) the usefulness of urinalysis in diagnosing UTI. We diagnosed UTI in 50 (5.3%) of 945 febrile infants if we found > or = 10,000 colony-forming units of a single pathogen per milliliter in a urine specimen obtained by catheterization. Prevalences were similar in (1) infants aged < or = 2 months undergoing examination for sepsis (4.6%), (2) infants aged > 2 months in whom UTI was suspected, usually because no source of fever was apparent (5.9%), and (3) infants with no suspected UTI, most of whom had other illnesses (5.1%). Female and white infants had significantly more UTIs, respectively, than male and black infants. In all, 17% of white female infants with temperature > or = 39 degrees C had UTI, significantly more (p < 0.05) than any other grouping of infants by sex, race, and temperature. Febrile infants with no apparent source of fever were twice as likely to have UTI (7.5%) as those with a possible source of fever such as otitis media (3.5%) (p = 0.02). Only 1 (1.6%) of 62 subjects with an unequivocal source of fever, such as meningitis, had UTI. As indicators of UTI, pyuria and bacteriuria had sensitivities of 54% and 86% and specificities of 96% and 63%, respectively. In infants with fever, clinicians should consider UTI a potential source and consider a urine culture as part of the diagnostic evaluation.