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URINARY INFECTION IN GENERAL PRACTICE DIAGNOSIS AND TREATMENT
Author(s) -
DAWBORN J. K.,
PAGE M.,
SCHIAVONE D. J.,
SEMMENS K.,
SMYTH J. L.
Publication year - 1973
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1973.tb110772.x
Subject(s) - urine , urinary system , medicine , nitrofurantoin , antibiotics , incidence (geometry) , microbiology and biotechnology , biology , antibiotic resistance , physics , optics
Sixty‐two female patients presenting with urinary symptoms in general practice were assessed on the basis of an examination of a single mid‐stream urine specimen. When allowance was made for contamination of the specimen by quantitative assessment of squamous epithelial cells in relation to pus cells in the urine, 37 out of 59 patients (63%) who were fully assessed were thought to have urinary infection. Seventy‐nine per cent of these also had evidence of vaginal infection. The organisms isolated were predominantly Gram‐negative bacilli, but Escherichia coli was present in only 52% of cases. In eight cases more than one organism was isolated. There was a high incidence of resistance to the commonly available oral antibiotics (20% to 30%), and a poor response overall to a seven‐day course of nitrofurantoin 50 mg four times daily. Only half of the patients who were followed up with culture and microscopy one to three weeks later were considered to be free of infection. No single antibiotic could be recommended on the basis of sensitivity tests to the organisms isolated from the urine and emphasis is placed on the need for initial bacteriological assessment and subsequent follow up. When a diagnosis of urinary infection must be made on a single mid‐stream urine specimen, it should be based not only on the bacterial colony count but on a critical assessment of the microscopic findings of pus in relation to squamous cells in the urine. The technique of urine collection to ensure an uncontaminated specimen is of prime importance. The degree of vaginal contamination can be assessed by measurement of the pus‐cell/squamous‐cell ratio in the urine which should be greater than 5 when pyuria is the result of urinary infection. The dipslide provides an accurate, simple and cheap method of assessing colony counts in the urine and avoids errors due to delay in inoculation of the medium. In conjunction with urine microscopy it provides a rapid diagnostic test as well as a convenient means of checking that treatment has been effective.