Dependence among host response parameters used to diagnose urinary tract infection

Article Abstract:

Escherichia coli (E. coli), a gram-negative bacteria, is present in the intestines of man and is widely distributed in nature. It is also a common cause of urinary tract infection (UTI). The symptoms of UTI include fever, inflammation of the kidney (identified by the presence of white blood cells in the urine), reduced ability of the kidney to filter urine, and pain during urination. The cell walls of gram-negative bacteria, such as E. coli, produce a substance called endotoxin, which stimulates the cells of the immune system to make proteins called cytokines. During UTI, cytokines such as interleukin-6 are produced and released into the blood. These cytokines cause fever and the production of other proteins, such as C-reactive protein (CRP). The diagnosis of UTI involves noting the presence of fever and CRP, and measuring the rate at which red blood cells, present in a blood sample in a test-tube, fall to the bottom of the tube (the erythrocyte sedimentation rate, or ESR). The relation between these diagnostic factors was evaluated in 692 children with UTI. The results revealed that fever, CRP, and ESR were significantly correlated in patients with UTI, meaning that they all occurred with UTI. The decreased ability of the kidneys to filter urine and the presence of blood cells in the urine were not related to the presence of fever, CRP or ESR. These findings suggest that fever, CRP and ESR occur together in UTI, and that they are caused by factors other than those responsible for altered kidney filtration and the presence of blood cells in urine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Physiological aspects, Endotoxins, C-reactive protein, Erythrocyte sedimentation rate

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Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients

Article Abstract:

Clostridium difficile infection is common among hospitalized patients, and may cause a wide range of illnesses, including antibiotic-associated diarrhea and colitis (inflammation of the colon). To determine the risk factors related to the nosocomial (related to and occurring during hospitalization) development of C. difficile-associated diarrhea, stool samples from hospitalized patients were screened for the presence of C. difficile. The study participants included 399 patients at the Harborview Medical Center in Seattle. Medical records were reviewed to determine the patients' medical conditions, clinical symptoms, diagnosis, and treatments received. During an 11-month period, asymptomatic C. difficile was identified in 13 of every 100 patients admitted to the hospital. Diarrhea caused by C. difficile occurred in 7.8 of every 100 patients admitted. Increased risk for developing C. difficile-associated diarrhea was related to increasing age, the severity of underlying illnesses, the use of antibiotics (particularly cephalosporin and penicillin), gastrointestinal stimulants, stool softeners, and enemas. Stool softeners and antacids were related to the development of asymptomatic C. difficile. The results indicate that C. difficile is a common nosocomial infection, related to about 20 percent of all cases of nosocomial diarrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Disease transmission, Clostridium infections, Seattle, Washington

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A retrospective cohort study of nosocomial diarrhea as a risk factor for nosocomial infection

Article Abstract:

Nosocomial infections, or infections acquired within the hospital, are a major source of illness. About 6 percent of all patients acquire a nosocomial infection, and 4 percent of those die either as a direct result of the infection or with the infection as a major contributing factor. Since the majority of nosocomial infections are the result of bacteria normally found in the digestive tract, it seems reasonable to investigate whether diarrhea might be a contributing factor to nosocomial infection. The cases of 78 patients (33 with diarrhea and 45 without) were reviewed to determine if diarrhea, along with other factors, might contribute to the development of infection. The results found that the presence of diarrhea contributes to the colonization of the urinary meatus and the subsequent development of a urinary tract infection. This likelihood is particularly great when the patient's urinary bladder is catheterized. The role of the urinary catheter in promotion of urinary tract infection has long been recognized, but the association of the catheter with the increased risk following diarrhea suggests that indwelling catheters probably should be removed following an episode of diarrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Diarrhea, Urinary catheterization

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