International Journal of STD & AIDS 1992; 3: 360-361
SHORT PAPER
Value of bacteriological screening of urine samples from HIV infected patients Marion Bain MB ChB BSc, F X S Emmanuel MB BS MRCPath, Lorna Willocks MB ChB MRCP, Frances Cowan MB BS MRCP and R P Brettle MB ChB FRCP Department of Bacteriology. and Infectious Diseases Unit, City Hospital, Edinburgh, EHlO 55B, UK Summary: A retrospective analysis of the results of bacteriological examination of all urine samples from adult HIV infected patients admitted to the City Hospital, Edinburgh during the year 1 April 1988 to 31 March 1989 was made to assess the usefulness of this investigation in HIV positive patients without clinical evidence of urinary tract infection. Keywords: Bacteriology, urinary tract infection, HIV, medical audit
INTRODUCTION Most research into infections in HIV positive individuals has concentrated on opportunistic infections. However common bacterial infections are a frequent cause of morbidity and mortalityl'" in this group of patients and screening for these may be of value. In this study we audit the results of bacteriological examination of urine samples from hospitalized HIV infected patients during a one year period in order to assess the value of routine screening of urine samples. PATIENTS AND METHODS One hundred and six patients who accounted for 180 admissions were included in the study. One hundred and eight of the admissions were men aged 16-58 years (average 32 years) and 72 were women aged 22-41 years (average 27 years). Seventy-eight per cent were injection drug users (lDUs), 12% were homosexuals, 7% had acquired the infection heterosexually, 1%from blood products and in 2% there were no documented risk factors. Sixty per cent of the patients were in group IV of the CDC Atlanta staging scheme 50% of whom had AIDS, 31% were in group III and 9% in group II. Thirty per cent of the 106 patients had AIDS. The results of 440 urine samples received for bacteriological investigation from 106 hospitalised HIV positive patients during the one year period from 1 April 1988 to 31 March 1989 were correlated with clinical information obtained from the medical case notes. Correspondence to: Dr Marion Bain, 7/4 Braehead Drive, Edinburgh EH4 6QH, UK
Urine samples were considered to be screening samples' in the absence of: (1) symptoms and signs of cystitis or pyelonephritis; or (2) clinical 'septic shock'; or (3) pregnancy. If pyrexia was present without any of the above the samples were also considered 'screening samples', but were analysed in a separate subcategory. All other urine samples were classified as 'nonscreening samples'. I
RESULTS Four hundred and forty urine samples from 106 patients were received in total during 180admissions. One hundred and eight of the admissions were men and 72 were women. Two pregnant women had five admissions between them. Of the 440 samples, 279 were considered 'screening samples' and were derived from 118 admissions (72 men and 46 women). There were 2 positive urinary cultures from the men and 6 from the women. The 2 men were in CDC group IV. The women were in CDC groups IV (2), III (2) and II (2). Eighty-one of the 279 samples were from patients with pyrexia and were derived from 36 admissions (26 men and 10 women). There were 2 positive urinary cultures within this subgroup (one man and one woman). A positive culture was obtained with two or fewer samples in all but one patient. In the single exception the positive culture was the 10th sample and was almost certainly a hospital-acquired infection. One hundred and sixty-one 'non-screening' samples were received from 63 admissions (35 men and 28 women). There were 2 positive urinary cultures from the men and 12 from the women, one
Bain et al. Bacteriological screening of urine in HIV
of whom was pregnant. One of the men was in CDC group IV and the other in group III. Nine of the 12 women were in CDC group IV, 2 in group III and one in group II. The number of samples required to obtain a positive culture ranged from one to five. The one episode which required 5 samples was probably due to a urinary tract infection acquired after admission to hospital. The organisms isolated from both screening and non-screening urine samples were the common ~rinary tract pathogens. Escherichia coli was isolated In 11 of the 22 positive cultures, Enterococci were found in 6 and there was one episode each of Urinary tract infection due to Enterobacter species, group B beta haemolytic streptococci, Klebsiella oxytoca, Klebsiella pneumoniae and mixed organisms. DISCUSSION
~t is now increasingly realized that common bacterial
Inf~ctions may cause substantial morbidity in
patIents with HIV infection. This study audited the Urinesamples received from a group of HIV positive patients to assess the value of routine screening of urine samples in patients without clinical evidence of urinary tract infection. The prevalence of asymptomatic bacteriuria in this group of HIV positive patients was almost 14% in women and 2% in men, considerably higher than the normal figure of 3-5% in women and 0.5% in mens. In women this difference is statistically
361
significant (P
SHORT PAPER
Value of bacteriological screening of urine samples from HIV infected patients Marion Bain MB ChB BSc, F X S Emmanuel MB BS MRCPath, Lorna Willocks MB ChB MRCP, Frances Cowan MB BS MRCP and R P Brettle MB ChB FRCP Department of Bacteriology. and Infectious Diseases Unit, City Hospital, Edinburgh, EHlO 55B, UK Summary: A retrospective analysis of the results of bacteriological examination of all urine samples from adult HIV infected patients admitted to the City Hospital, Edinburgh during the year 1 April 1988 to 31 March 1989 was made to assess the usefulness of this investigation in HIV positive patients without clinical evidence of urinary tract infection. Keywords: Bacteriology, urinary tract infection, HIV, medical audit
INTRODUCTION Most research into infections in HIV positive individuals has concentrated on opportunistic infections. However common bacterial infections are a frequent cause of morbidity and mortalityl'" in this group of patients and screening for these may be of value. In this study we audit the results of bacteriological examination of urine samples from hospitalized HIV infected patients during a one year period in order to assess the value of routine screening of urine samples. PATIENTS AND METHODS One hundred and six patients who accounted for 180 admissions were included in the study. One hundred and eight of the admissions were men aged 16-58 years (average 32 years) and 72 were women aged 22-41 years (average 27 years). Seventy-eight per cent were injection drug users (lDUs), 12% were homosexuals, 7% had acquired the infection heterosexually, 1%from blood products and in 2% there were no documented risk factors. Sixty per cent of the patients were in group IV of the CDC Atlanta staging scheme 50% of whom had AIDS, 31% were in group III and 9% in group II. Thirty per cent of the 106 patients had AIDS. The results of 440 urine samples received for bacteriological investigation from 106 hospitalised HIV positive patients during the one year period from 1 April 1988 to 31 March 1989 were correlated with clinical information obtained from the medical case notes. Correspondence to: Dr Marion Bain, 7/4 Braehead Drive, Edinburgh EH4 6QH, UK
Urine samples were considered to be screening samples' in the absence of: (1) symptoms and signs of cystitis or pyelonephritis; or (2) clinical 'septic shock'; or (3) pregnancy. If pyrexia was present without any of the above the samples were also considered 'screening samples', but were analysed in a separate subcategory. All other urine samples were classified as 'nonscreening samples'. I
RESULTS Four hundred and forty urine samples from 106 patients were received in total during 180admissions. One hundred and eight of the admissions were men and 72 were women. Two pregnant women had five admissions between them. Of the 440 samples, 279 were considered 'screening samples' and were derived from 118 admissions (72 men and 46 women). There were 2 positive urinary cultures from the men and 6 from the women. The 2 men were in CDC group IV. The women were in CDC groups IV (2), III (2) and II (2). Eighty-one of the 279 samples were from patients with pyrexia and were derived from 36 admissions (26 men and 10 women). There were 2 positive urinary cultures within this subgroup (one man and one woman). A positive culture was obtained with two or fewer samples in all but one patient. In the single exception the positive culture was the 10th sample and was almost certainly a hospital-acquired infection. One hundred and sixty-one 'non-screening' samples were received from 63 admissions (35 men and 28 women). There were 2 positive urinary cultures from the men and 12 from the women, one
Bain et al. Bacteriological screening of urine in HIV
of whom was pregnant. One of the men was in CDC group IV and the other in group III. Nine of the 12 women were in CDC group IV, 2 in group III and one in group II. The number of samples required to obtain a positive culture ranged from one to five. The one episode which required 5 samples was probably due to a urinary tract infection acquired after admission to hospital. The organisms isolated from both screening and non-screening urine samples were the common ~rinary tract pathogens. Escherichia coli was isolated In 11 of the 22 positive cultures, Enterococci were found in 6 and there was one episode each of Urinary tract infection due to Enterobacter species, group B beta haemolytic streptococci, Klebsiella oxytoca, Klebsiella pneumoniae and mixed organisms. DISCUSSION
~t is now increasingly realized that common bacterial
Inf~ctions may cause substantial morbidity in
patIents with HIV infection. This study audited the Urinesamples received from a group of HIV positive patients to assess the value of routine screening of urine samples in patients without clinical evidence of urinary tract infection. The prevalence of asymptomatic bacteriuria in this group of HIV positive patients was almost 14% in women and 2% in men, considerably higher than the normal figure of 3-5% in women and 0.5% in mens. In women this difference is statistically
361
significant (P
