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This chapter, reviews the basics for children undergoing abdominal mass resections. Combined with the chapter on nephroblastoma, the authors discuss the incidence, diagnosis and perioperative considerations for patients undergoing resection of large abdominal tumors. The anesthetic evaluation and planning for these patients is presented with the relative tumor specific management principles.
In this study, the aim was to investigate the correlation between the acute and habitual dietary intake of flavanones, and their main food sources, and the concentrations of aglycones naringenin and hesperetin in 24h urine in a European population. A 24-h dietary recall (24-HDR) and a 24-h urine sample were collected the same day from a subsample of 475 people from 4 different countries of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Acute and habitual dietary data were captured through a standardized 24-HDR and a country/centre-specific validated dietary questionnaire. The intake of dietary flavanones was estimated using the Phenol-Explorer database. Urinary flavanones (naringenin and hesperetin) were analysed using tandem mass spectrometry with a previous enzymatic hydrolysis. Weak partial correlation coefficients were found between urinary flavanone concentrations and both acute and habitual dietary flavanone intakes (Rpartial=0.14-0.17). Partial correlations were stronger between urinary excretions and acute intakes of citrus fruit and juices (Rpartial~0.6) than with habitual intakes of citrus fruit and juices (Rpartial~0.24). In conclusion, according to our results urinary excretion of flavanones can be considered good biomarkers of acute citrus intake. However, low associations between habitual flavanone intake and urinary excretion suggest a possible inaccurate estimation of their intake or a too sporadic intake. For assessing habitual exposures, multiple urinary collections may be needed. These results show that none of the approaches tested is ideal, and the use of both dietary questionnaires and biomarkers can be recommended.
A variety of studies have investigated endocrinological aspects of ecology, cooperation and immune system activation in Taï chimpanzees, making use of the ever-growing number of validated biomarkers used on non-invasive samples by the endocrinology laboratory at the MPI EVAN. In particular, the measurement of urinary oxytocin allows for insights into benefits of food-sharing, bonds and the potential physiological mechanism behind cooperation. Measures of urinary cortisol in combination with creatinine and C-peptide allow for the investigation of causes of seasonal variation in stress levels while patterns of immune system activation are monitored by the measurement of urinary neopterin. Future studies will profit from combined analysis of endocrine and immune parameters in relation to behaviour and reproductive success to investigate life-history trade-offs. Across-site comparisons of behaviour and endocrine patterns will help us to understand how variation in ecological and physiological parameters form the social setting of a population which leads to relatively low intergroup hostility, low leverage of males over females and relatively high levels of female sociality at Taï.
It has become increasingly apparent that different chimpanzee populations behave differently. Most behaviours and vocalizations are observed across all or most populations. Some behaviours, however, are specific to few populations and different populations behave disparately when solving the same problems. Instead of speaking about the ‘typical’ behaviours, one can probably speak better of a range of chimpanzee behaviours. Between populations, behaviours can range widely. For good comparability and to avoid biases, observers either need to unilaterally use the same protocol or it needs to be apparent how and which data have been collected. Here, we clarify the protocol under which long-term data are collected by the Taï Chimpanzee Project. Despite regular changes to improve and update long-term data collection, our core data collection has remained unchanged, allowing use of the whole data set in analyses. With this chapter, not only can we interpret results generated from the Taï database with more accuracy, but also provide more accessibility for comparisons than currently available. One of the outcomes of this chapter will be making comparisons across study populations easier.
Urine is a critical nitrogen (N) input in temperate grazed grasslands and can drive substantial nitrous oxide (N2O) production in soils. However, it remains unclear how differences in the N input rate affect N2O fluxes and vary between different grassland soils. The effect of increasing urine N application on ammonium (NH4+), nitrite (NO2−) and nitrate (NO3−) concentrations and N2O production was tested in two grassland soils, a free-draining loam and an imperfectly drained sandy-loam. It was hypothesized that high-urine N application rates would lead to ammonia/ammonium (NH3/NH4+) accumulation influencing N transformation rates and N2O production which differ between grassland soils. Fresh cattle urine was applied at rates equivalent to 300 and 1000 kg N/ha in an aerobic incubation experiment. Soils were destructively sampled over 80 days to measure changes in inorganic-N and pH. The higher N addition rate was associated with elevated NH3 concentrations up to day 35 in soils, probably inhibiting NO2− to NO3− reduction. In contrast, there was no inhibition of nitrification in the 300 kg N/ha treatment. Cumulative N2O fluxes were greatest from the 300 kg N/ha treatment for the loam soil, but were greater for the sandy-loam under the 1000 kg N/ha treatment. The results also show that differences in soil properties, in particular carbon availability, can be important in regulating N transformation and N2O production. Collectively, these results demonstrate the proposed mechanism of nitrification inhibition at high-N input rates, driven by either high NH3/NH4 and/or increased levels of NH4HCO3 from urea hydrolysis.
Although common beans (Phaseolus vulgaris L.) are consumed worldwide, studies on the metabolic fate of phenolic compounds from common beans are still very scarce. The present work aimed to study the bioavailability of phenolic compounds in human plasma and urine, after acute consumption of a single meal of cooked common beans. Blood and urine of seven volunteers were collected before (0 h) and at different time points (1, 2, 4, 6 and 8 h, for plasma and 0-2, 2-4, 4-6, 6-8, 8-24 h for urine) after beans’ intake. UPLC-Q-TOF-MS was used for quantification. After beans’ intake (405 ± 3 g), containing 457 mg of phenolic compounds (expressed as gallic acid equivalents), there was a significant increase (p < 0.05) in the plasma concentration of 6 metabolites, and in the urinary excretion of 11 metabolites. After 1 h post-consumption, metabolites, such as kaempferol-3-O-glucuronide, showed a significant increase in plasma concentration, suggesting kaempferol’s glucuronidation in the upper gastrointestinal tract. More than 50% of the total amount of metabolites, such as 4-methylcatechol-O-sulfate and dihydrocaffeic acid-3-O-sulfate, were excreted after 8 h post-consumption, indicating colonic bacterial metabolism of the phenolic compounds. Throughout PLS-DA models the classification of biological samples, collected from the different volunteers, clearly showed clusters of metabolites, which contributed to extend the list of compounds related to cooked common beans’ human intake at different time points and showed the human inter-individual variability in plasma concentration, as well as, in the amount of urinary excreted metabolites, after cooked common beans’ intake.
Saliva and urine are the two main body fluids sampled when breastmilk intake is measured with the deuterium oxide dose-to-mother technique. However, these two body fluids may generate different estimates of breastmilk intake due to differences in isotope enrichment. Therefore, we aimed to assess how the estimated amount of breastmilk intake differs when based on saliva and urine samples and to explore whether the total energy expenditure of the mothers is related to breastmilk output. We used a convenience sample of 13 pairs of mothers and babies aged 2 to 4 months, who were exclusively breastfed and apparently healthy. To assess breastmilk intake, we administered doubly labelled water to the mothers, and collected saliva samples from them, while simultaneously collecting both saliva and urine from their babies over a 14-day period. IRMS was used to analyze the samples for deuterium and oxygen-18 enrichments. Mean breastmilk intake based on saliva samples was significantly higher than that based on urine samples (854.5g/day vs. 812.8g/day, p=0.029). This can be attributed to slightly higher isotope enrichments in saliva and to a poorer model fit for urine samples as indicated by a higher square root of the mean square error (14.6 vs. 10.4 mg/kg, p=0.001). Maternal energy expenditure was not correlated with breastmilk output. Our study suggests that saliva sampling generates slightly higher estimates of breastmilk intake and is more precise as compared to urine and that maternal energy expenditure does not influence breastmilk output.
To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples.
A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics.
Iranian adults recruited in 2014–2015.
Healthy volunteer adults aged ≥18 years.
With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (−469 to −708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (–151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50).
In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.
To evaluate the daily Se intake of 3- to 5-year-old Japanese children, we used seventy-two urine samples collected from fifty-three children (twenty-seven male and twenty-six female) from two cities in Miyagi prefecture, Japan. For measuring low Se concentrations with high precision, accuracy and rapidity in the 24-h urine samples, we developed an instrumental neutron activation analysis (INAA) method, that is without any chemical separation, using the short-lived 77mSe (t1/2 = 17·4 s) nuclide. The estimated Se intake of the fifty-three children was 51·5 (sd 30·2) µg/d (geometric mean: 42·7 µg/d). Ten subjects (three male and seven female), successfully provided 24-h urine samples over two or three consecutive days; their Se intake was 37·4 (sd 5·9) µg/d. Based on the logarithmically transformed data of these ten subjects, the ratio of intra-/inter-individual variances of usual Se intake was 16·7 (28·0/1·7) and geometric mean was 27·7 µg/d. The 5th to 95th percentile of usual Se intake of these ten subjects was 17·5 to 40·4 µg/d, which ranged between the recommended dietary allowance and tolerable upper intake level of Se by the Dietary Reference Intakes for Japanese (2015).
Evaluation of Cr, Mn, Fe, Zn and Se in humans is challenged by the potentially high within-individual variability of these elements in biological specimens, which are poorly characterised. This study aimed to evaluate their within-day, between-day and between-month variability in spot samples, first-morning voids and 24-h collections. A total of 529 spot urine samples (including eighty-eight first-morning voids and 24-h collections) were collected from eleven Chinese adult men on days 0, 1, 2, 3, 4, 30, 60 and 90 and analysed for these five elements using inductively coupled plasma-MS. Intraclass correlation coefficients (ICC) were utilised to characterise the reproducibility, and their sensitivity and specificity were analysed to assess how well a single measurement classified individuals’ 3-month average exposures. Serial measurements of Zn in spot samples exhibited fair to good reproducibility (creatinine-adjusted ICC = 0·47) over five consecutive days, which became poor when the samples were gathered months apart (creatinine-adjusted ICC = 0·33). The reproducibility of Cr, Mn, Fe and Se in spot samples was poor over periods ranging from days to months (creatinine-adjusted ICC = 0·01–0·12). Two spot samples were sufficient for classifying 60 % of the men who truly had the highest (top 33 %) 3-month average Zn concentrations; for Cr, Mn, Fe and Se, however, at least three specimens were required to achieve similar sensitivities. In conclusion, urinary Cr, Mn, Fe, Zn and Se concentrations showed a strong within-individual variability, and a single measurement is not enough to efficiently characterise individuals’ long-term exposures.
The aim of this study was to assess the validity of the predictive INTERSALT equation using spot urine samples to estimate 24-h urinary Na (24-hUNa) excretion and daily Na intake among the French adult population. Among 193 French adults (‘validation sample’), we assessed the validity by comparing predicted 24-hUNa excretion from spot urine and measured 24-hUNa excretion from 24-h urine collections. Spearman correlation coefficients and Bland–Altman plots were used and we calculated calibration coefficients. In a nationally representative sample of 1720 French adults (‘application sample’), the calibrated predictive equation was then applied to the spot urine Na values to estimate 24-hUNa excretion and daily Na intake. In that sample, predicted Na intake was compared with that estimated from 24-h dietary recalls. Results were adjusted and corrected using calibration coefficients. In the validation sample, the measured 24-hUNa excretion was on average 14 % higher than the predicted 24-hUNa (+13 % for men and +16 % for women). Correlation between measured and predicted 24-hUNa excretion was moderate (Spearman r 0·42), and the Bland–Altman plots showed underestimation at lower excretion level and overestimation at higher level. In the application study, estimated daily salt intake was 8·0 g/d using dietary recalls, 8·1 g/d using predicted INTERSALT equation and 9·3 g/d after applying calibration coefficients calculated in the validation study. Despite overall underestimation of 24-hUNa excretion by spot urinary Na, the use of predictive INTERSALT equation remains an acceptable alternative in monitoring global Na intake/excreted in the French population but its use is not advised at the individual level.
Associations between ferritin and insulin sensitivity have been described in recent studies. The possible association showed conflicting results by sex and menopausal status. We aimed to investigate the cross-sectional association of ferritin levels with insulin resistance and β-cell function. A total of 2518 participants (1033 men, 235 pre-menopausal women and 1250 post-menopausal women) were enrolled from the Changfeng Study. A standard interview was conducted, as well as anthropometric measurements and laboratory analyses, for each participant. The serum ferritin level was measured using electrochemiluminescence immunoassay. Insulin resistance and β-cell function indices were derived from a homeostasis model assessment. The results showed that the serum ferritin levels were 250·4 (sd 165·2), 94·6 (sd 82·0) and 179·8 (sd 126·6) ng/ml in the men, pre-menopausal and post-menopausal women, respectively. In fully adjusted models (adjusting for age, current smoking, BMI, waist:hip ratio, systolic blood pressure, diastolic blood pressure, TAG, HDL-cholesterol, LDL-cholesterol, log urine albumin:creatinine ratio, leucocytes, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transpeptidase), serum ferritin concentrations are significantly associated with insulin resistance in men and post-menopausal females, and the null association was observed in pre-menopausal females. Interestingly, an increased β-cell function associated with higher ferritin was observed in post-menopausal participants, but not in male participants. In conclusion, these results suggested that elevated serum ferritin levels were associated with surrogate measures of insulin resistance among the middle-aged and elderly male and post-menopausal women, but not in pre-menopausal women.
Estrus synchronization is important for optimal management of gilt reproduction in pig farms. Hormonal treatments, such as synthetic progestogens, are used on a routine basis, but there is a growing demand for non-hormonal alternative breeding tools. Before puberty, gilts exhibit a ‘waiting period,’ related to the ovarian development and gonadotrophin secretions, during which external stimulations, such as boar exposure, could induce and synchronize first ovulation. Practical non-invasive tools for identification of this period in farms are lacking. During this period, urinary oestrone levels are high, but urine sampling is difficult in group-housed females. The aim of this work was to search for specific biomarkers of the ‘waiting period’ in saliva and urine. In total, nine 144- to 147-day-old Large White gilts were subjected to trans-abdominal ultrasonography three times a week for 5 weeks until puberty detection (week –5 to week –1 before puberty). Urine and saliva samples were collected for oestrone assay to detect the ‘waiting period’ and for metabolome analysis using 1H-nuclear magnetic resonance spectroscopy to detect potential biomarkers of the ‘waiting period.’ Gilts were slaughtered 7 days after puberty detection for puberty confirmation. Results were consistent with ultrasonography data for six gilts. Urine and saliva samples from these six gilts were analyzed. Urinary estrone concentration significantly increased 2 weeks before puberty detection. Metabolome analysis of urine samples allowed the identification of 78 spectral bins, among them, 42 low-molecular-weight metabolites were identified. Metabolome analysis of salivary samples allowed the identification of 59 spectral bins, among them, 23 low-molecular-weight metabolites were detected and 17 were identified. No potential biomarker was identified in urinary samples. In saliva, butyrate and 2HOvalerate, 5.79 ppm (putatively uridine), formate, malonate and propionate could be biomarker candidates to ascertain the pre-puberty period in gilt reproduction. These results confirm that non-invasive salivary samples could allow the identification of the physiological status of the gilts and presumably the optimal time for application of the boar effect. This could contribute to synchronize puberty onset and hence to develop non-hormonal breeding tools.
Introduction: Inspired by the Choosing Wisely® campaign, St. Michaels Hospital (SMH) launched an initiative to reduce unnecessary tests, treatments and procedures that may cause patient harm. Stakeholder engagement identified inappropriate ordering of urine culture & sensitivities (C&S) in the emergency department (ED) as a focus area. Inappropriate urine C&S increase workload, healthcare costs and detection of asymptomatic bacteriuria which can lead to unnecessary antibiotics. The project’s purposes were to describe the scope of inappropriately ordered urine C&S in the SMH ED and to conduct a root-cause analysis to inform future quality improvement interventions. Methods: Criteria for determining appropriateness was developed a priori using evidence-based guidelines from the University Health Network together with additional literature review. A retrospective chart review was performed on all urine C&S ordered in the ED from Jun 1 Aug 30, 2016. Each chart was reviewed for order appropriateness, demographic information and ordering provider. All inappropriate urine C&S were reviewed to identify root causes which were then grouped into common themes. A pareto chart was constructed to analyze the frequency of causes. Results: Of 425 urine C&S ordered, 75 (17.7%) were inappropriate. The top 3 reasons were: inappropriate urosepsis work-ups (53%), order processing errors (17%) and inappropriate work-ups for weakness (16%). Inappropriate urosepsis work-ups were defined as urine C&S that were ordered empirically despite there being a clear focus for infection elsewhere (i.e. cough, cellulitis) and in the absence of urinary symptoms. Order processing errors were defined as urine C&S which were sent despite there being no documented order. Inappropriate testing was more likely to occur overnight, in females and when a urine routine and microscopy was not ordered prior to C&S. 29% of patients with inappropriate C&S received antibiotics. Conclusion: 17.7% of urine C&S ordered in the SMH ED during the 3-month study period were inappropriate. The top cause was septic patients who were empirically tested despite having another source for infection identified from the outset. A possible reason for this is the recent ED emphasis on early recognition of sepsis which may encourage early use of antibiotics and empiric urine C&S. One question to resolve is whether a 17.7% overutilization rate is sufficient to make it a target for change. Interventions designed to reduce inappropriate urine C&S may inadvertently increase the number of missed cultures in patients admitted with sepsis not yet diagnosed. Next steps involve discussions between the ED, Internal Medicine, Infectious Disease and Microbiology, and patient partners to identify patient-centered change ideas and sustainable strategies. This may involve establishing guidelines for ordering urine C&S and incorporating lab services to provide oversight into urine C&S processing.
Programmatic surveillance of intestinal schistosomiasis during control can typically use four diagnostic tests, either singularly or in combination, but these have yet to be cross-compared directly. Our study assembled a complete diagnostic dataset, inclusive of infection intensities, from 258 children from five Ugandan primary schools. The schools were purposely selected as typical of the endemic landscape near Lake Albert and reflective of high- and low-transmission settings. Overall prevalence was: 44.1% (95% CI 38.0–50.2) by microscopy of duplicate Kato-Katz smears from two consecutive stools, 56.9% (95% CI 50.8–63.0) by urine-circulating cathodic antigen (CCA) dipstick, 67.4% (95% CI 61.6–73.1) by DNA-TaqMan® and 75.1% (95% CI 69.8–80.4) by soluble egg antigen enzyme-linked immunosorbent assay (SEA-ELISA). A cross-comparison of diagnostic sensitivities, specificities, positive and negative predictive values was undertaken, inclusive of a latent class analysis (LCA) with a LCA-model estimate of prevalence by each school. The latter ranged from 9.6% to 100.0%, and prevalence by school for each diagnostic test followed a static ascending order or monotonic series of Kato-Katz, urine-CCA dipstick, DNA-TaqMan® and SEA-ELISA. We confirm that Kato-Katz remains a satisfactory diagnostic standalone in high-transmission settings but in low-transmission settings should be augmented or replaced by urine-CCA dipsticks. DNA-TaqMan® appears suitable in both endemic settings though is only implementable if resources permit. In low-transmission settings, SEA-ELISA remains the method of choice to evidence an absence infection. We discuss the pros and cons of each method concluding that future surveillance of intestinal schistosomiasis would benefit from a flexible, context-specific approach both in choice and application of each diagnostic method, rather than a single one-size fits all approach.
Measurement of mean population Na and K intakes typically uses laboratory-based assays, which can add significant logistical burden and costs. A valid field-based measurement method would be a significant advance. In the current study, we used 24 h urine samples to compare estimates of Na, K and Na:K ratio based upon assays done using the field-based Horiba twin meter v. laboratory-based methods.
The performance of the Horiba twin meter was determined by comparing field-based estimates of mean Na and K against those obtained using laboratory-based methods. The reported 95 % limits of agreement of Bland–Altman plots were calculated based on a regression approach for non-uniform differences.
The 24 h urine samples were collected as part of an ongoing study being done in rural China.
One hundred and sixty-six complete 24 h urine samples were qualified for estimating 24 h urinary Na and K excretion.
Mean Na and K excretion were estimated as 170·4 and 37·4 mmol/d, respectively, using the meter-based assays; and 193·4 and 43·8 mmol/d, respectively, using the laboratory-based assays. There was excellent relative reliability (intraclass correlation coefficient) for both Na (0·986) and K (0·986). Bland–Altman plots showed moderate-to-good agreement between the two methods.
Na and K intake estimations were moderately underestimated using assays based upon the Horiba twin meter. Compared with standard laboratory-based methods, the portable device was more practical and convenient.
The present study set out to determine whether morning spot urine samples can be used to monitor Na (and K) intake levels in South Africa, instead of the ‘gold standard’ 24 h urine sample.
Participants collected one 24 h and one spot urine sample for Na and K analysis, after which estimations using three different formulas (Kawasaki, Tanaka and INTERSALT) were calculated.
Between 2013 and 2015, urine samples were collected from different population groups in South Africa.
A total of 681 spot and 24 h urine samples were collected from white (n 259), black (n 315) and Indian (n 107) subgroups, mostly women.
The Kawasaki and the Tanaka formulas showed significantly higher (P≤0·001) estimated Na values than the measured 24 h excretion in the whole population (5677·79 and 4235·05 v. 3279·19 mg/d). The INTERSALT formula did not differ from the measured 24 h excretion for the whole population. The Kawasaki formula seemed to overestimate Na excretion in all subgroups tested and also showed the highest degree of bias (−2242 mg/d, 95 % CI−10 659, 6175) compared with the INTERSALT formula, which had the lowest bias (161 mg/d, 95 % CI−4038, 4360).
Estimations of Na excretion by the three formulas should be used with caution when reporting on Na intake levels. More research is needed to validate and develop a specific formula for the South African context with its different population groups. The WHO’s recommendation of using 24 h urine collection until more studies are carried out is still supported.
In vitro studies have shown several beneficial properties of resveratrol. Epidemiological evidence is still scarce, probably because of the difficulty in estimating resveratrol exposure accurately. The current study aimed to assess the relationships between acute and habitual dietary resveratrol and wine intake and urinary resveratrol excretion in a European population. A stratified random subsample of 475 men and women from four countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) cross-sectional study, who had provided 24-h urine samples and completed a 24-h dietary recall (24-HDR) on the same day, were included. Acute and habitual dietary data were collected using standardised 24-HDR software and a validated country-specific dietary questionnaire, respectively. Phenol-Explorer was used to estimate the intake of resveratrol and other stilbenes. Urinary resveratrol was analysed using tandem MS. Spearman’s correlation coefficients between estimated dietary intakes of resveratrol and other stilbenes and consumption of wine, their main food source, were very high (r>0·9) when measured using dietary questionnaires and were slightly lower with 24-HDR (r>0·8). Partial Spearman’s correlations between urinary resveratrol excretion and intake of resveratrol, total stilbenes or wine were found to be higher when using the 24-HDR (R2partial approximately 0·6) than when using the dietary questionnaires (R2partial approximately 0·5). Moderate to high correlations between dietary resveratrol, total stilbenes and wine, and urinary resveratrol concentrations were observed. These support the earlier findings that 24-h urinary resveratrol is an effective biomarker of both resveratrol and wine intakes. These correlations also support the validity of the estimation of resveratrol intake using the dietary questionnaire and Phenol-Explorer.
To determine the number of urine cultures ordered for women who presented to the emergency department (ED) with symptoms of uncomplicated UTI, and whether a culture result impacted subsequent management.
This was a retrospective chart review of non-pregnant women aged 18-39 presenting to one of two academic EDs with a discharge diagnosis of uncomplicated UTI over a one-year study period. Patients were excluded if there was documentation of fever, immunocompromised state, diabetes mellitus, absence of lower urinary tract symptoms, ED administration of intravenous antibiotics, a previous UTI treated with antibiotics in the last 90 days, two weeks post-partum or post-instrumentation.
Of the 512 charts included in the analysis, 494 (96.5%) patients had a urinalysis, of which 463 (93.7%) had positive leukocyte esterase and 90 (18.2%) had positive nitrites. 370 patients (72.3%) had urine cultures performed, of which 236 (63.8%) were positive. 505 (98.6%) patients received antibiotics (53.9% Macrobid; 22.6% Ciprofloxacin; 15.0% Septra; 6.7% other; 1.8% not documented). 7 (1.9%) cultures grew organisms resistant to the prescribed antibiotic; 2 (0.5%) patients received new prescriptions.
For the majority of young female patients with an uncomplicated UTI, urine cultures did not change management in the ED setting. However, when the diagnosis is uncertain based on symptomology and urinalyses alone, a urine culture may be warranted. Greater efforts should be directed towards educating emergency physicians on accurately diagnosing uncomplicated cystitis and the limited impact of urine cultures on treatment once a diagnosis has been made.