Letters to the Editor The number of urine specimens for bacteriological examination in women Ertugrul Guclu, Tuba Damar, Oguz Karabay Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey. Cite this as: Ertugrul Guclu, Tuba Damar, Oguz Karabay. The number of urine specimens for bacteriological examination in women. Afr Health Sci. 2013;13(4): 11 78 - 11 78 (L3) We read the article entitled “Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon”, with great interest. As stated by the authors, asymtomatic bacteriuria (ASB) is a major concern in diabetics and especially in this group there is insufficient and discrepancy information on the occurence.1 The diagnosis is the most important step in managing ASB. As stated in the article the most important point in the diagnosis is microbiological tests. In this context the number of specimens for culture is crucial. In the guidelines, ASB in men is defined as the isolation of > 105 cfu/mL bacteria in a single clean-catch voided urine specimen. On the other hand in women, two consecutive urine specimen is needed for an accurate diagnosis2,3. However in the present study, authors did not define the number of urine cultures in women. Whereas the number of urine cultures is crucial in women, we cannot say there was no contamination with only one positive culture.
References 1. Bissong ME, Fon PN, Tabe-Besong FO, Akenji TN. Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon. Afr Health Sci. 2013 Sep;13(3):661-6 2. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America; American Society of Nephrolog y; American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):64354. 3. Fekete T. Hooton TM. Approach to the adult with asymptomatic bacteriuria. http:// www.uptodate.com/contents/approach-to-theadult-with-asymptomatic-bacteriuria
Bissong et al reply: Cite this as: Marie E. A. Bissong, Peter N. Fon, Fritz O. Tabe-Besong and Theresa N. Akenji. Bacteriuria in diabetes mellitus patients in Cameroon: number of urine specimens in women Afr Health Sci 2013; 13(4): 1178 - 1179 (L4) We acknowledge receipt of Ertugrul Guclu’s letter to the Editor 1 concerning our article entitled “Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon”2. The main concern was the number of urine specimen for bacteriological examination for women. In the present study, both men and women were recruited and the criterion used for defining asymptomatic bacteriuria was the presence of at least 105 CFU/ ml in a single culture of clean-voided mid-stream urine specimen. It has been reported that two consecutive urine specimen is needed for a proper diagnosis or ASB in women3. In the present study, we used a single urine specimen per subject as previously reported4, 5; however, strict hygiene measures such as hand washing and vulval cleaning/separation were ensured to avoid vaginal contamination. Although measures were taken to avoid contamination, we cannot say it was completely ruled out. Marie E. A. Bissong. Email: [email protected] 1178
African Health Sciences Vol 13 Issue 4 December 2013
References 1. Ertugrul Guclu, Tuba Damar, Oguz Karabay. The number of urine specimens for bacteriological examination in women. Afr Health Sci. 2013;13(4): L3. 2. Marie E. A. Bissong, Peter N. Fon, Fritz O. TabeBesong, Theresa N. Akenji. Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon. Afr Health Sci 2013; 13(3): 661 – 666; DOI: http://dx.doi.org/10.4314/ ahs.v13i3.20. 3. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; Infectious Diseases Society of America; American Society of Nephrolog y; American Geriatric Society.
African Health Sciences Vol 13 Issue 4 December 2013
Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005; 40(5):64354. 4. Bonadio M, Costarelli S, Morelli G, Tartaglia T. The influence of diabetes mellitus on the spectrum of uropathogens and the antimicrobial resistance in elderly adult patients with urinary tract infection. Biomed Central Infectious Diseases 2006, 6(54): 1-7 5. Lyamuya EF, Moyo SJ, Komba EV, Haule M. Prevalence, antimicrobial resistance and associated risk factors for bacteriuria in diabetic women in Dar es Salaam, Tanzania. African Journal of Microbiology Research 2011; 5(6): 683-689.
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References 1. Bissong ME, Fon PN, Tabe-Besong FO, Akenji TN. Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon. Afr Health Sci. 2013 Sep;13(3):661-6 2. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America; American Society of Nephrolog y; American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):64354. 3. Fekete T. Hooton TM. Approach to the adult with asymptomatic bacteriuria. http:// www.uptodate.com/contents/approach-to-theadult-with-asymptomatic-bacteriuria
Bissong et al reply: Cite this as: Marie E. A. Bissong, Peter N. Fon, Fritz O. Tabe-Besong and Theresa N. Akenji. Bacteriuria in diabetes mellitus patients in Cameroon: number of urine specimens in women Afr Health Sci 2013; 13(4): 1178 - 1179 (L4) We acknowledge receipt of Ertugrul Guclu’s letter to the Editor 1 concerning our article entitled “Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon”2. The main concern was the number of urine specimen for bacteriological examination for women. In the present study, both men and women were recruited and the criterion used for defining asymptomatic bacteriuria was the presence of at least 105 CFU/ ml in a single culture of clean-voided mid-stream urine specimen. It has been reported that two consecutive urine specimen is needed for a proper diagnosis or ASB in women3. In the present study, we used a single urine specimen per subject as previously reported4, 5; however, strict hygiene measures such as hand washing and vulval cleaning/separation were ensured to avoid vaginal contamination. Although measures were taken to avoid contamination, we cannot say it was completely ruled out. Marie E. A. Bissong. Email: [email protected] 1178
African Health Sciences Vol 13 Issue 4 December 2013
References 1. Ertugrul Guclu, Tuba Damar, Oguz Karabay. The number of urine specimens for bacteriological examination in women. Afr Health Sci. 2013;13(4): L3. 2. Marie E. A. Bissong, Peter N. Fon, Fritz O. TabeBesong, Theresa N. Akenji. Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon. Afr Health Sci 2013; 13(3): 661 – 666; DOI: http://dx.doi.org/10.4314/ ahs.v13i3.20. 3. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; Infectious Diseases Society of America; American Society of Nephrolog y; American Geriatric Society.
African Health Sciences Vol 13 Issue 4 December 2013
Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005; 40(5):64354. 4. Bonadio M, Costarelli S, Morelli G, Tartaglia T. The influence of diabetes mellitus on the spectrum of uropathogens and the antimicrobial resistance in elderly adult patients with urinary tract infection. Biomed Central Infectious Diseases 2006, 6(54): 1-7 5. Lyamuya EF, Moyo SJ, Komba EV, Haule M. Prevalence, antimicrobial resistance and associated risk factors for bacteriuria in diabetic women in Dar es Salaam, Tanzania. African Journal of Microbiology Research 2011; 5(6): 683-689.
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