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  • Title: [Urinary tract infections at the hospital and the ambulatory service: etiology and laboratory diagnosis].
    Author: De Stefano A, Benedicti D.
    Journal: Minerva Urol Nefrol; 1992; 44(4):239-44. PubMed ID: 1299002.
    Abstract:
    An aetiology study was conducted into urinary tract infections (UTI) in order to compare hospital infections with those in outpatients identified from samples sent to the laboratory by general practitioners. Urine culture analysis was performed on 3,483 samples of which 740 came from hospital patients and 2,743 from outpatients. The diagnosis of UTI was based on new criteria: not only the assessment of bacterial proliferation but also clinical factors like sex, symptoms, sampling technique and urinary leucocyte count and the traditional threshold of 10 units forming colonies (UFC/ml) was ignored. In other words the following were all considered positive: all bacterial growths > or = 10(5) UFC/ml independent of other data, all those > or = 10(2) UFC/ml in symptomatic women, those > or = 10(3) UFC/ml in symptomatic men and those > or = 10(2) UFC/ml in catheterised patients. In cases supplied with incomplete anamnestic data bacterial proliferations in the 10(2)-10(5) UFC/ml range were considered positive if the leucocyte count was also significant. The frequency of the various micro-organisms isolated from the positive urine cultures of the two group was then assessed. The study revealed that among outpatients relatively innocuous bacterial like E. Coli, Klebsiella and Proteus accounted for over 75% of UTI cases, but less than 44% among hospital patients. By contrast, more "serious" bacteria like Pseudomonas, Acinetobacter and Serratia were identified in about 20% of hospital cases but only about 5% of outpatients. Finally a comparison was made between in- and outpatient multibacterial UTI which were found to be more common and more aetiologically heterogeneous in hospital patients than in outpatients.
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