Skip to main content
Log in

The epidemiology of urinary tract infection and the concept of significant bacteriuria

Epidemiologie der Harnwegsinfektionen und das Konzept der signifikanten Bakteriurie

  • UTIs: An Overview
  • Published:
Infection Aims and scope Submit manuscript

Summary

Urinary tract infections (UTI) are among the most common infections afflicting man. Urinary tract infections in young adult women are usually uncomplicated, but are often recurrent and cause considerable morbidity. Urinary tract infections in pregnant women, elderly patients, and catheterized patients warrant special attention because of their association with increased morbidity and possibly with increased mortality. Diagnosis of UTI is usually based on quantitation of uropathogens in voided urine. The traditional criteria for significant bacteriuria, ≥105 uropathogens per ml of voided urine, is insensitive for detecting acute symptomatic cystitis in men and women and should be replaced with a lower colony count threshold.

Zusammenfassung

Harnwegsinfektionen gehören zu den häufigsten Infektionskrankheiten des Menschen. Bei jungen Frauen sind Harnwegsinfektionen in der Regel unkompliziert, doch sind rezidivierende Verläufe häufig, und die Morbidität ist beträchtlich. Bei Schwangeren, älteren Personen und Katheterträgern auftretende Harnwegsinfektionen verdienen besondere Beachtung, da nicht nur die Morbidität erhöht ist, sondern möglicherweise auch die Mortalität. Die Diagnose einer Harnwegsinfektion basiert in der Regel auf der Keimzahlbestimmung im Spontanurin. Für die Diagnose einer akuten Zystitis bei Männern und Frauen ist der traditionelle Richtwert für eine signifikante Bakteriurie von ≥105 uropathogenen Keimen pro ml zu wenig empfindlich, aus diesem Grund sollten die Grenzwerte für die Keimzahlen niedriger angesetzt werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Center for Health Statistics 1985 Summary. National ambulatory medical care survey. Adv. Data 128 (1985) 1–8.

    Google Scholar 

  2. Abbott, G. D. Neonatal bacteriuria: A prospective study in 1460 infants. Br. Med. J. i (1972) 267–269.

    Google Scholar 

  3. Jodal, U. The natural history of bacteriuria in childhood. Infect. Dis. Clin. North Am. 1 (1987) 713–729.

    Google Scholar 

  4. Barnes, R. C., Daifuku, R., Roddy, R. E., Stamm, W. E. Urinary tract infection in sexually active homosexual men. Lancet i (1986) 171–173.

    Google Scholar 

  5. Kunin, C. M. Detection, prevention and management of urinary tract infections. 4th ed. Lea and Febiger, Philadelphia 1987, pp. 57–124.

    Google Scholar 

  6. Kaye, D. Urinary tract infections in the elderly. Bull. N.Y. Acad. Med. 56 (1980) 209–220.

    Google Scholar 

  7. Boscia, J. A., Kaye, D. Asymptomatic bacteriuria in the elderly. Infect. Dis. Clin. North Am. 1 (1987) 893–905.

    Google Scholar 

  8. Sanford, J. P. Urinary tract symptoms and infection. Ann. Rev. Med. 26 (1975) 485–498.

    Google Scholar 

  9. McGeachie, J. Recurrent infection of the urinary tract: Reinfection or recrudescence? Br. Med. J. i (1966) 952–954.

    Google Scholar 

  10. Stamm, W. E. Recent developments in the diagnosis and treatment of urinary tract infections. West J. Med. 137 (1982) 213–220.

    Google Scholar 

  11. Schaeffer, A. J., Jones, J. M., Dunn, J. K. Association ofin vitro Escherichia coli adherence to vaginal and buccal epithelial cells with susceptibility of women to recurrent urinary tract infections. N. Engl. J. Med. 304 (1981) 1062–1066.

    Google Scholar 

  12. Stamey, T. A. The role of introital enterobacteria in recurrent urinary infections. J. Urol. 109 (1973) 467–472.

    Google Scholar 

  13. Nicolle, L. E., Harding, G. K. M., Preiksaitis, J., Ronald, A. R. The association of urinary tract infections with sexual intercourse. J. Infect. Dis. 146 (1982) 579–583.

    Google Scholar 

  14. Fihn, S. D., Latham, R. H., Roberts, P., Running, K., Stamm, W. E. et al.: Association between diaphragm use and urinary tract infection. JAMA 254 (1985) 240–245.

    Google Scholar 

  15. Fihn, S. D., Johnson, C., Roberts, P. L., Running, K., Stamm, W. E. Trimethoprim-sulfamethoxazole for acute dysuria in women: A single-dose or 10-day course. Ann. Intern. Med. 108 (1988) 350–357.

    Google Scholar 

  16. Kass, E. H. Bacteriuria and pyelonephritis of pregnancy. Arch. Intern. Med. 105 (1960) 194–198.

    Google Scholar 

  17. Norden, C. W., Kass, E. H. Bacteriuria of pregnancy. A critical appraisal. Ann. Rev. Med. 19 (1968) 431–470.

    Google Scholar 

  18. Harris, R. E. The significance of eradication of bacteriuria during pregnancy. Obstet. Gynecol. 53 (1979) 71–73.

    Google Scholar 

  19. Naeye, R. L. Causes of the excessive rates of perinatal mortality and prematurity in pregnancies complicated by maternal urinary-tract infections. New Engl. J. Med. 300 (1979) 819–823.

    Google Scholar 

  20. Kass, E. H. Prevention of apparently non-infectious diseases by detection and treatment of infections of the urinary tract. J. Chron. Dis. 15 (1962) 665–673.

    Google Scholar 

  21. Haley, R. W., Culver, D. H., White, J. W., Morgan, W. M., Emori, T. G. The nation-wide nosocomial infection rate. A new need for vital statistics. Am. J. Epidemiol. 121 (1985) 159–167.

    Google Scholar 

  22. Haley, R. W., Hooton, T. M., Culver, D. H., Stanley, R. C., Emori, T. G., Hardison, C. D., Quade, D., Schachtman, R. H., Schaberg, D. R., Shah, B. V., Schatz, G. D. Nosocomial infections in US hospitals, 1975–76. Estimated frequency by selected characteristics of patients. Am. J. Med. 70 (1981) 947–959.

    Google Scholar 

  23. Kreger, B. E., Craven, D. E., Carling, P. C., McCabe, W. R. Gram-negative bacteremia: III. Reassessment of etiology, epidemiology, and ecology in 612 patients. Am. J. Med. 68 (1980) 332–343.

    Google Scholar 

  24. Platt, R., Polk, B. F., Murdock, B., Rosner, B. Mortality associated with nosocomial urinary-tract infection. New Engl. J. Med. 307 (1982) 637–642.

    Google Scholar 

  25. Wong, E. S., Hooton, T. M. Guidelines for prevention of catheter-associated urinary tract infections. Infect. Control 2 (1980) 125–130.

    Google Scholar 

  26. Rubin, R. H. Infections of the urinary tract. Scient. Am. Med. 23 (1984) 1–12.

    Google Scholar 

  27. Kunin, C. M. Detection, prevention and management of urinary tract infections. 4th ed. Lea and Febiger, Philadelphia 1987, p. 159.

    Google Scholar 

  28. Johnson, J. R., Stamm, W. E. Diagnosis and treatment of acute urinary tract infections. Infect. Dis. Clin. North Am. 1 (1987) 773–791.

    Google Scholar 

  29. Haley, R. W. Incidence and nature of endemic and epidemic nosocomial infections. In:Bennett, J. V., Brachman, P. S. (eds.): Hospital Infections. Little, Brown and Company, Boston, Toronto 1986, pp. 359–374.

    Google Scholar 

  30. Kass, E. H. Chemotherapeutic and antibiotic drugs in the management of infections of the urinary tract. Am. J. Med. 18 (1955) 764–781.

    Google Scholar 

  31. Kass, E. H. Asymptomatic infections of the urinary tract. Trans. Ass. Amer. Physicians 69 (1956) 56–64.

    Google Scholar 

  32. Stamm, W. E. Quantitative urine cultures revisited. Eur. J. Clin. Microbiol. 3 (1984) 279–281.

    Google Scholar 

  33. Stamm, W. E., Counts, G. W., Running, K. R., Fihn, S., Turck, M., Holmes, K. K. Diagnosis of coliform infection in acutely dysuric women. N. Engl. J. Med. 307 (1982) 463–468.

    Google Scholar 

  34. Smith, G. W., Brumfitt, W., Hamilton-Miller, J. Diagnosis of coliform infection in acutely dysuric women (letter). N. Engl. J. Med. 309 (1983) 1393–1394.

    Google Scholar 

  35. Lipsky, B. A., Ireton, R. C., Fihn, S. D., Hackett, R., Berger, R. E. Diagnosis of bacteriuria in men: Specimen collection and culture interpretation. J. Infect. Dis. 155 (1987) 847–854.

    Google Scholar 

  36. Stark, R. P., Maki, D. G. Bacteriuria in the catheterized patient. What quantitative level of bacteriuria is relevant? N. Engl. J. Med. 311 (1984) 560–564.

    Google Scholar 

  37. Monzon, O. T., Ory, E. M., Dobson, H. L. A comparison of bacterial counts of the urine obtained by needle aspiration of the bladder, catheterization and midstream voided methods. N. Engl. J. Med. 259 (1958) 764.

    Google Scholar 

  38. Stamm, W. E.: Measurement of pyuria and its relation to bacteriuria. Am. J. Med. 75 (Suppl 1B) 53–58.

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hooton, T.M. The epidemiology of urinary tract infection and the concept of significant bacteriuria. Infection 18 (Suppl 2), S40–S43 (1990). https://doi.org/10.1007/BF01643424

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01643424

Keywords

Navigation