Consulta ginecológica de rotina: quais exames solicitar? / Routine gynecological appointments: which exams apply?

Atualmente é crescente o número de mulheres atingidas por doenças como Hipertensão Arterial Sistêmica (HAS), Diabetes, Osteoporose e mesmo cânceres, como os de mama e cólon. O médico ginecologista, muitas vezes, é a única referência de saúde destas pacientes. Este artigo visa reunir as recomendações das principais Sociedades Médicas no que diz respeito ao rastreio das comorbidades citadas e os demais cuidados básicos de saúde da mulher. Ele objetiva, portanto, facilitar e ampliar a abordagem prática do ginecologista no consultório para que a mulher seja avaliada de uma maneira mais completa.(AU)

The number of women suffering from diseases such as Systemic Arterial Hypertension, Diabetes, Osteoporosis and breast and colon cancers has grown in the latest decades. The gynecologist is oftenly the only reference in medical care for these women. This article groups the main recommendations from different Medical Societies regarding the tracking of these conditions and other basic aspects on women's health care. It aims to facilitate and broaden the gynecologists' practical approach in evaluating women in a more complete way.(AU)

Preditores clínicos de bacteriúria assintomática na gestação / Clinical predictors of asymptomatic bacteriuria during pregnancy

OBJETIVOS: Estimar a prevalência de bacteriúria assintomática (BAS) entre gestantes atendidas em pré-natal de Serviço Universitário e identificar prováveis preditores clínicos. MÉTODOS: Estudo prospectivo de corte transversal, envolvendo 260 gestantes matriculadas em serviço de pré-natal de baixo risco entre agosto de 2008 e outubro de 2009, sem sintomas de infecção do trato urinário. Foram excluídas aquelas com febre, disúria, tenesmo vesical, dor lombar, presença de sangramento genital, perda de líquido amniótico, uso de antimicrobianos nos últimos 30 dias e aquelas que não desejaram participar do projeto. A presença de colonização bacteriana ≥10(5) UFC/mL de único patógeno, na amostra urinária obtida do jato médio, foi considerada como a variável dependente. As variáveis estudadas foram: idade, raça, estado civil, nível de instrução, história obstétrica, idade gestacional, anemia, traço falciforme, colpite, passado de infecção do trato urinário, polaciúria, urgência miccional e incontinência urinária. Dados do sumário de urina também foram analisados, como a presença de leucocitúria, flora bacteriana aumentada, hematúria, proteinúria e nitrito. A análise estatística foi realizada com o programa Statistical Package for the Social Sciences (SPSS) 13.0 e a significância estatística foi previamente definida por valor p<0,05. As prevalências foram expressas por percentual e intervalo de confiança considerado foi de 95 por cento. RESULTADOS: A prevalência de foi de 12,3 por cento (IC95 por cento=8,3-16,3). O agente etiológico mais frequente foi a E. coli (59,4 por cento). A regressão logística indicou que a urgência miccional (OR=5,9; IC95 por cento=2,2-16,3; p<0,001), a leucocitúria (OR=2,8; IC95 por cento=1,0-7,8; p=0,04) e a flora bacteriana aumentada (OR=10,6; IC95 por cento=3,9-28,5; p<0,001), são preditores independentes de BAS durante a gestação. CONCLUSÃO: A prevalência de bacteriúria assintomática na população estudada é alta. O escore preditor criado com o modelo final de regressão logística possui uma acurácia de 91,9 por cento para bacteriúria.

PURPOSE: To estimate the prevalence of asymptomatic bacteriuria among pregnant women attended at our university prenatal care clinic and to identify probable clinical predictors. METHODS: Across-sectional study was carried out from August 2008 to October 2009 at the Bahiana School of Medicine involving 260 pregnant women without symptoms of urinary tract infection. The following exclusion criteria were considered: presence of clinical signs such as fever, dysuria, vesical tenesmus, lumbar pain, history of active genital bleeding or loss of amniotic fluid, use of antimicrobial agents in the 30 days prior to sample collection, and refusal to participate in the project. The presence of single pathogen bacterial colonization ≥10(5) CFU/mL in the urine sample obtained from the middle jet was considered to be a dependent variable. The predictive factors evaluated were as follows: age, race, marital status, schooling, gestational age, hypertension, anemia, vaginal infection, sickle cell trait and previous history of urinary tract infection, urinary symptoms related to the lower urinary tract (frequency, urgency and nocturia) and data obtained from the urine summary (leukocyturia, increased bacterial flora, hematuria, proteinuria, and presence of nitrite). Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) software version 13.0 and the level of significance was set at p<0.05. Prevalences were expressed as percentage, and the confidence interval considered was 95 percent (95 percentCI). RESULTS: The prevalence of asymptomatic bacteriuria was 12.3 percent (95 percentCI=8.3-16.3). E. coli was the most frequent etiologic agent (59.4 percent). Logistic regression indicated that urgency to void (OR=5.99; 95 percentCI=2.20-16.31; p<0.001); leukocyturia (OR=2.85; 95 percentCI=1.04-7.83; p=0.042) and increased bacterial flora (OR=10.62; 95 percentCI=3.95-28.56; p<0.001) were independent predictors of asymptomatic bacteriuria. CONCLUSION: The prevalence of asymptomatic bacteriuria in the studied population was high. The prediction score created for the final logistic regression model has an accuracy of 91.9 percent for bacteriuria.

Infecção do trato urinário na gravidez: aspectos atuais / Urinary tract infection in pregnancy: atual concepts

A infecção do trato urinário caracteriza-se pela invasão e multiplicação de micro-organismos nos rins e nas vias urinárias. Na maioria das vezes, é resultado da colonização da urina por bactérias fecais, que cresceram em meio anaeróbio, sendo a E. coli o patógeno mais comumente envolvido nessas infecções. A ITU é uma das mais comuns infecções bacterianas na mulher, sendo que pelo menos 40 porcento das mulheres adultas têm pelo menos um episódio de ITU em suas vidas. Manifesta-se clinicamente por disúria, polaciúria, urgência miccional e dor no baixo ventre na cistite, arrepios de frio e lombalgia na pielonefrite, ou completa ausência de sintomas na bacteriúria assintomática. O diagnóstico, na maioria das vezes, com exceção da bacteriúria assintomática, é clínico. A gravidez é situação que predispõe ao aparecimento de ITU, devido às mudanças fisiológicas (mecânicas e hormonais) que ocorrem nesse período da vida da mulher. A ITU durante a gravidez pode causar sérias complicações, como o trabalho de parto pré-termo, recém-nascidos de baixo peso, rotura prematura de membranas, restrição de crescimento intraútero, paralisia cerebral, entre outras. O objetivo da presente revisão foi abordar os principais fatores etiológicos, o diagnóstico e a conduta nos casos de ITU durante a gravidez.

Urinary tract infection (UTI) is characterized by the invasion and multiplication of microorganisms in the kidneys and in the urinary tract. Most of the time, it is the result of the urine being colonized by fecal bacteria, developing in anaerobic environment, and E. coli is the most commonly pathogen involved in those infections. UTI is one of the most common bacterial infections in women, and at least 40 percent of adult women have at least one episode of UTI in their lives. Its clinical presentation involves disuria, polaciuria, urinary urgency and pain in the lower womb in cystitis, chills and lombalgia in the kidney infection, or complete absence of symptoms in the asymptomatic bacteriuria. The diagnosis, most of the time, except for asymptomatic bacteriuria, is clinical. Pregnancy is a situation that predisposes to the emergence of UTI, due to the physiologic changes (mechanical and hormonal), that happen in this period of woman's life. UTI during pregnancy can cause serious complications, as preterm labor, low weight newborns, premature rupture of membranes, intra-uterine growth restriction, cerebral palsy, among others. The purpose of this review is to present the main etiological factors, the diagnosis and the conduct while dealing with UTI cases during pregnancy.

Infecção urinária / Urinary tract infections

A infecção do trato urinário (ITU), uma das afecções mais frequentes nos Serviços de Saúde, possui espectro variável de apresentação clínica, abrangendo cistite, pielonefrite e bacteriúria assintomática. A severidade e recorrência das ITU estão relacionadas a fatores genéticos, hormonais e comportamentais juntamente com a virulência do micro-organismo invasor. Os autores revisitam o tema, chamando atenção para a importância do diagnóstico diferencial e trazem uma visão atualizada dos esquemas antibióticos propostos para tratamento e prevenção, segundo as últimas diretrizes internacionais. Outras modalidades terapêuticas alternativas são também abordadas.

Infecção do trato urinário na gravidez: aspectos diagnósticos, terapêuticos e prognósticos / Urinary tract infection in pregnancy: diagnostic, therapeutic and prognostic aspects

Infecção do trato urinário é complicação comum na gravidez devido às mudanças anatômicas e funcionais, sendo responsável por elevado número de complicações mateno-fetais. Em decorrência de sua importância, o presente trabalho faz atualização das recentes evidências quanto ao manejo dessa afecção. Ao final do primeiro trimestre, recomenda-se a triagem para bacteriúria asintomática em todas as gestantes. Mulheres com bacteriúria assintomática ou infecção urinária sintomática durante a gravidez devem ser tratadas e submeterem-se a screenings periódicos durante toda a gestação. Os beta-lactâmicos são os antibióticos de escolha para o tratamento dessas gestantes. Evidências sugerem uso de terapia oral por três a sete dias para cistite e parenteral de 14 dias para pielonefrite. As pacientes devem realizar urocultura de controle com 48 ou 72 horas de tratamento. A profilaxia é indicada em casos especívicos em dose única pós-coital ou diariamente com cefalexina ou nitrofurantoína. O presente artigo ainda discute a conduta em situações especiais, como em pacientes com litíase renal, traço falcêmico e ureterossigmoidostomia.

Urinary tract infection is a common complication of pregnancies due to functional, anatomic and hormonal changes. Given its importance, this current article reviews the current evidence on handling of this illness. At the end of the first trimester, a screening for asymptomatic bacteriuria is recommended for all pregnant women. The ones with asymptomatic bacteriuria or symptomatic UTI during childbearing should be treated and submitted to periodical screenings during all gestation period. The beta-lactams are the antibiotics chosen for the treatment of these pregnant women. Evidence suggests the use of 3 to 7 day oral therapy against cystitis and 14 day parenteral therapy against pielonefhritis. The patients should undergo urine culture within 48 or 72 hours of treatment. The single dose prophylaxis is indicated in specific cases after coitus or on a daily basis with the prescription of cephalexin or nitrofurantoin. This article still discusses the management in special situations, such as renal lithiasis, ureterossigmoidostomy and sickling trace.

Asymptomatic bacteriuria among pregnant women referred to outpatient clinics in Sanandaj, Iran

OBJECTIVES: Determine the prevalence of asymptomatic urinary tract infection (AUTI) among pregnant women. We also determined the antibacterial susceptibility of the isolates to various antibiotics and associated risk factors in AUTI. MATERIALS AND METHODS: One thousand five hundred and five consecutive pregnant women were included in the study. Mid-stream urine specimen for complete examination of urine was obtained. RESULTS: Of 1505 pregnant women, 134 (8.9 percent) had bacteriuria. The mean age of the all the pregnant women included in the study was 28.40 years with a standard deviation of 6.16. Age ranged from 15 to 45 years of age. The urine culture of the asymptomatic pregnant women (1505 cases) showed growth in only 134 cases (8.9 percent). Escherichia coli was the commonest organism 79 (58.96 percent) followed by CN Staphylococcus 22 (16.8 percent) and S aureus 18 (13.43 percent). Escherichia coli, which comprised 58.96 percent (79) of the isolates, were 88.62 percent, 87.35 percent, and 83.55 percent sensitive to cefotaxime, ciprofloxacin and cefotizoxime respectively. Similarly, E. coli were 89 percent, 70 percent, and 20 percent resistant to ampicillin, cotrimoxazole, and nitrofurantoin respectively (OR 1.57 95 percent CI 1.01, 2.44). After analyzing, four variables, hemoglobin levels seem to be independently associated with asymptomatic bacteriuria (OR = 9.41 (1.65-50.38). CONCLUSION: Prevalence of asymptomatic bacteriuria among pregnant women was 8.9 percent. The predominant organisms were Escherichia coli 79 (58.96 percent), followed by CN Staphylococcus 22 (16.8 percent). Most strains of Escherichia coli showed that they were resistant to ampicillin, tetracycline and gentamicin.

Reagent strip testing for antenatal screening and first meaningful of asymptomatic bacteriuria in pregnant women.

OBJECTIVE: To evaluate the diagnostic performance of reagent strip test as a screening test for asymptomatic bacteriuria (ABU) in pregnant women. MATERIAL AND METHOD: Three hundred and sixty asymptomatic pregnant women who attended their first antenatal appointment at Rajavithi Hospital from August 1st to October 31st, 2005 were enrolled Those with symptoms of urinary tract infection within one month, those who had been prescribed antibiotics during the previous 7 days, and those with medical or obstetric complications, vaginal bleeding and a history of urinary tract diseases were excluded Urine specimens were collected by clean-catched midstream urine technique for urine dipstick and culture. RESULTS: The prevalence of ABU was 10.0% The urine dipstick nitrite leukocyte esterase and combined test had a sensitivity of 16.7%, 75.0% and 16.7%, specificity of 99.1%, 67.9% and 99.4%, positive predictive value of 66.7%, 20.6% and 75.0%, negative predictive value of 91.5, 96.1% and 91.5%, accuracy of 90.8%, 68.6% and 91.1%, respectively. CONCLUSION: Reagent strip testing indicated a fair sensitivity for routine antenatal screening for asymptomatic bacteriuria in pregnant women

Evaluation of various screening tests to detect asymptomatic bacteriuria in pregnant women.

To evaluate the diagnostic efficacy of various screening tests in detecting asymptomatic bacteriuria among pregnant women. Clean catch midstream urine specimens were collected from 630 consecutive pregnant women and processed. Forty-four (7.4%) of the urine samples were culture positive, with Escherichia coli as the predominant organism isolated (57.4%). The results of the four screening tests, viz., Gram's staining of uncentrifuged urine, pus cell count, nitrite test and leukocyte esterase (LE) test, were compared against urine culture. Gram's stain of the uncentrifuged urine was found to be the single most useful test with a sensitivity and negative predictive value (NPV) of 85.1% and 98.8%, respectively. Pus cell count was the least sensitive. Neither the nitrite test nor the LE test alone was sensitive enough with 74.4% and 61.7%, respectively. However, when either or both tests positive were considered, it increased the sensitivity and NPV comparable with Gram's staining results, with 82.9% and 98.8%, respectively. With the potential to be used as an office diagnostic procedure, the combined nitrite and LE dipstick test may provide an acceptable alternative.

Aplicabilidade do TTC para a detecção de bacteriúria / Applicability of TTC test to bacteriuria detection

Exames laboratoriais para detecção da infecção urinária com custo menor que da urocultura têm sidobuscados. O cloridrato de trifeniltetrazólio foi avaliado em 342 amostras de urina paralelamente à urocultura objetivando a detecção de bacteriúria significativa. Os resultados demonstraram que o teste apresenta boa sensibilidade (91,3%) e baixa especificidade (64,3%), com valor preditivo negativo de 99,0%. Apesar do teste não substituir a urocultura como método diagnóstico, pode ser recomendado para a triagem de bacteriúria, eliminando a realização da cultura em amostras negativas.

Prevalência de infecções do trato urinário e bacteriuria em gestantes da clínica ginecológica do ambulatório materno infantil de Tubarão – SC no ano de 2005 / Prevalence of urinary infection and asymptomatic bacteriuria in pregnant in a clinics in south Brazil

Introdução: A prevalência de bacteriúria assintomática é de 10 % na gravidez. A Escherichia coli corresponde a 80-90% das infecções. A cultura de urina deveser usada como um procedimento de rotina na primeira visita pré-natal. O tratamento da bacteriúria assintomáticaprevine complicações na gestação como pielonefrite aguda. Objetivos: Determinar a prevalência de infecção dotrato urinário em gestantes da clínica ginecológica do Ambulatório Materno Infantil de Tubarão-SC no período de 2005. Métodos: Foi realizado um estudo observacional, descritivo sobre registros secundários de todas as gestantes(17 - 40 anos) do Ambulatório Materno Infantil de Tubarão no período 01/01/2005 a 31/12/2005. Resultados: Das 192 gestantes, 70 (36,46%) pacientes foram incluídas com alterações clínicas e/ou laboratoriais de infecção do trato urinário. A solicitação de urocultura foi realizada em 28 (40%) pacientes. Destas, 11 (39,29%) apresentaram urocultura positiva, sendo a Escherichia coli mais prevalente em 45,45%. Prevalência de tratamento medicamentoso nas gestantes queapresentaram alterações clínicas e/ou laboratoriais foi de 45,71%. Conclusões: Urocultura continua sendo o melhor método diagnóstico para infecção do trato urinário. Solicitá-la precocemente na primeira visita pré-natal para diagnosticar e tratar os casos de bacteriúria assintomática torna-se imprescindível para prevenir uma futuracomplicação.

Introduction: The prevalence of asymptomatic bacteriuria is 10% during pregnancy. The Escherichia coli bacterium is responsible for 80-90% of the infections. The urine culture should be used as a routine procedure in the first pre-natal visit. The treatment of asymptomatic bacterium prevents complications during pregnancy such as acute pyelonephritis. Objectives: To determinate the prevalence of urinarytract infection in pregnant women at the Ambulatório Materno Infantil – Tubarão– SC during the period of 2005. Methodology: A descriptive Observational study was realized using secondary records of all pregnant woman (17-40 years old) of the Ambulatório Materno Infantil ofTubarão in the period from January 1st 2005 through December 31st 2005. The information was typed in a file created by the “Epi-data Program” and analyzed in the “Epi-Info Program”. The averages were compared by Kruskal-Wallis test, the proportions by qui-square testor Fisher exact test, when correspondent. Results: Of the 192 pregnant woman, 70 (36,46%)patients were included with clinical and/or laboratorial alterations of urinary tract infection. The uroculture request was realized in 28 (40%) patients. Among them, 11 (39,29%) presented positive uroculture, Escherichia coli being the most prevalent bacteria (45,45%). Theprevalence of the women that presented clinical and/or laboratorial alterations that were treated was 45,71%.Conclusions: Uroculture continues to be the best diagnostics methods for infection of urinary tract. Its earlyrequest in the fist pre-natal visit to diagnose and treat the asymptomatic bacteriuria becomes indispensable inpreventing future complications.

Asymptomatic bacteriuria in users of intrauterine devices

The aim of this study was to compare the frequency of asymptomatic bacteriuria in women who use intrauterine devices [lUDs] as contraceptive method with subjects who use tubal ligation [TL]. A cohort study was conducted on women who were candidates for IUD insertion or TL [control]. The patients were followed for three months, and urine cultures were assessed for bacteriuria at the end of study. Overall, 131 women [mean age, 31.9 +/- 4.25 years] in the IUD group and 78 [mean age, 32.1 +/- 4.0 years] in the control group were studied. The parity score was 2 or more in 72% of the women in the IUD group and in 74% of the controls. The average intercourse frequency was twice per week in 82% of IUD users and 80% of controls. Fifty-seven percent of the women in IUD group and 55%ofthe women in the control group had graduated from secondary school [high school]. Asymptomatic bacteriuria was detected in 13 IUD users [9.9%] and in 1 woman [1.3%] in the control group [risk ratio = 7.74, confidence interval: 1.03 to 58.03; P =.019]. The detected microorganism in the urine culture was Escherichia coli in 12 IUD users and in 1 patient in control group. Klebsiella was found in 1 IUD user. Use of an IUD is a risk factor for urinary tract infection and should be considered, especially in women with recurrent urinary tract infections

Infección urinaria en el geronte / Urinary tract infection in the elderly

La infección urinaria es una patología común en el geronte. Esta población presenta diversos factores de riesgo, tales como la edad, la insuficiencia renal crónica y otras comorbilidades, el uso frcuente de sondas vesicales, que favorecen la incidencia de dichas infecciones. Se describe una actualización acerca de la etiología, las manifestaciones clínicas, el diagnóstico y tratamiento de las infecciones urinarias en grupos epidemiológicos seleccionados.

Evaluation of urinalysis parameters to predict urinary-tract infection

We evaluated the performance of automated-flow cytometry, urinalysis dipsticks and microscopic urine sediment analysis as predictors of urinary tract infection. Urine cultures were used as a reference method for comparison. Six-hundred-seventy-five urine samples from hospitalized and not hospitalized patients attended at Hospital Mãe de Deus, Porto Alegre, in south Brazil, were included in the study. Among the individual measures analyzed, intense bacteriuria in the microscopic analysis of urinary sediment gave an accuracy of 92.9 percent. A combination between intense bacteriuria (microscopic analysis) and >20 leukocytes per µL of urine (flow cytometry) gave a higher accuracy (97.3 percent). We conclude that though it is laborious, microscopic urinalysis is a good analytical tool. Taken together with flow cytometry and dipsticks, we obtained a clinically-acceptable prediction of urinary-tract infection.

Eficacia de nitrofurantoina y amoxicilina en el tratamiento de bacteriuria asitomática en mujeres embarazadas en la sala de alto riesgo obstétrico en el Hospital Escuela Oscar Danilo Rosales Arguello en el período comprendido de julio a diciembre 2005 / Nitrofurantoina effectiveness and amoxicilina in the treatment of bacteriuria asitomática in women embarrassed in the room of high obstetric risk in the Hospital School Oscar Danilo Rosales Arguello in the understood period of July to December 2005

En la relación del presente estudio se incluyeron a 98 pacientes que cumplan con los criterios de inclusión, de cuyos resultados se pude inferir que: en relación a la edad gestacional el 63.3 porciento de las pacientes cursaban tercer trimestre de embarazo, seguido de 17.3 porciento que cursaba su segundo trimestre y solamente 16.6 porciento se encontraba en la etapa inicial de su gestación. Respecto a las alteraciones del examen de orina se observó que 80.7 porciento presento bacteriuría y solamente 12.2 porciento se evidencio la presencia de leucocitos y en 7.1 porciento de nitritos. Correlacionando examen general de orina y urocultivo se encontró que de las 98 pacientes en las que se encontró alteración del EGO 37 tuvieron cultivo negativo lo que representa 37.8 porciento y un 62.2 porciento correspondiente a 61 pacientes se evidencio la presencia de germen patógeno. De las 61 pacientes con crecimiento en el urocultivo se encontró la presencia de E coli en 29 pacientes para 47.5 porciento, seguido de enterobacter con 19.9 porciento en 12 pacientes y el tercer lugar correspondio a Klesiella con 16.3 porciento en 10 pacientes. Respecto a la sensibilidad bacteriana para E coli el germen más frecuente fue de 89.6 porciento para Nitrofurantoina en comparación con 82.7 porciento para amoxicilina, no siendo a´si con enterobacter cuya sensibilidad para amoxicilina fue de 100 porciento en contra de 75 porciento para Nitrofurantoina, en relación a Klebsiella predomino su sensibilidad a Nitrofurantoina con 80 porciento. En relación a la eficacia de ambos fármacos estudiados se encontró que de las 34 pacientes que recibieron esquema de Nitrofuranotina 30 presentaron curación para 88.2 porciento y solamente en 4 pacientes persistió el germen para 11.8 porciento. Las que recibieron esquema 2 con amoxicilina fueron 27 pacientes se observó su curación en 16 pacientes para 59.2 porciento y fracaso en 11 con 40.8 porciento...

Prevalence and complications of asymptomatic bacteriuria during pregnancy

To study the prevalence and complications of asymptomatic bacteriuria during pregnancy. Descriptive Study [Cross. Sectional]. October 2001 to March 2002. There were 3000 houses in Satellite town and extension Behari colony Bahawalpur. Taking 40% of total, 1200 houses were selected by systemic random sampling and pregnant residents of these houses were included in the study. 580 ladies fulfilling the inclusion criteria were interviewed and tested for bacteriuria by Dip Stick test. 28 women had bacteriuria giving prevalence of 4.8%. Culture and sensitivity tests showed E-Coli to be the causative organism in 78.6% while 21.4% cases were due to other organisms. 35.7% bacteriuric women had positive past history of UTI compared to only 9.7% non-bacteriuriac women giving significant result regarding risk of recurrent infection [p<0.05]. Prevalence of anaemia was not much different in the two groups, 85.7% compared with 82.6%. [p>0.05]. Development of PIH was not found to be affected by bacteriuria as 10.7% bacteriuric and 8.9% non bacteriuric women developed PIH [p >0.05]. Similarly number of low birth weight babies was not much different in the two groups, 7.1% compared with 6.2% [p>0.05]. Bacteriuria was found to be a causative factor for preterm labour as 21.4% bacteriuric women compared with 4.9% non-bacteriuric women went into preterm labour [p<0.05]. Bacteriuria was found to increase the risk of symptomatic UTI as 14.2% bacteriuric and 2.7% non-bacteriuric women developed cystitis. [p<0.05]. Asymptomatic bacteriuria is a common infection during pregnancy and it increases the risk of symptomatic UTI and preterm birth

Nitrito urinário e infecção do trato urinário por cocos gram-positivos / Urinary nitrite and urinary-tract infection by gram-positive cocci

INTRODUÇÃO: A infecção do trato urinário (ITU) é uma das mais comuns na clínica médica. Os testes que utilizam tiras reagentes detectam significativamente mais infecções por bactérias gram-negativas do que por espécies gram-positivas, uma vez que o teste de nitrito não revela a presença de patógenos gram-positivos em muitos casos. OBJETIVOS: Explorar a microbiologia e a freqüência de infecção urinária por cocos em adultos sintomáticos, relacionando-as com o resultado de nitrito urinário, para traçar o perfil epidemiológico desses pacientes. MATERIAL E MÉTODO: Um estudo retrospectivo foi conduzido na Secretaria de Saúde do município de Maringá-PR, no período de abril de 2004 a março de 2005. RESULTADOS: Amostras de urina de 3.426 pacientes foram coletadas e analisadas. Um total de 448 (13,1 por cento) amostras foi positivo para cultura. Em 388 (86,6 por cento) casos houve crescimento de bacilos gram-negativos (BGN) e em 60 (13,4 por cento) casos, cocos gram-positivos (CGP). A análise estatística de co-morbidades revelou diferença significativa na proporção de pacientes com hipertensão (31,3 por cento com nitrito positivo versus 4,5 por cento com nitrito negativo, p < 0,05). Os pacientes com resultado de nitrito positivo relataram febre em proporção maior que os com nitrito negativo (75 por cento versus 43,2 por cento, respectivamente; p < 0,05). Staphylococcus aureus redutores de nitrato mostraram maior resistência à ciprofloxacina (66,7 por cento) quando em comparação com os isolados não-redutores (100 por cento sensíveis). CONCLUSÕES: Este estudo preliminar mostrou que a avaliação de sinais clínicos e sintomas, juntamente com o resultado de nitrito urinário na tira reagente, poderia auxiliar o médico na tomada de decisões importantes.

BACKGROUND: Urinary tract infection (UTI) is among the most common infections in medical center. Urinalysis tests detect significantly more gram-negative infections than those due to gram-positive bacteria because the urinary nitrite test does not detect the presence of gram-positive pathogens in many cases. OBJECTIVES: Explore the microbiology and frequency of UTI by coccus in symptomatic adult patients, comparing them with urinary nitrite results, in order to delineate the epidemiological profile of these patients. MATERIAL AND METHOD: Retrospective analysis was conducted from April 2004 through March 2005 at Health Center, Maringa, Brazil. RESULTS: Urine specimens from 3,426 patients were collected and examined. A total of 448 (13.1 percent) samples had positive culture results. There were 388 (86.6 percent) strains of gram-negative rods and 60 (13.4 percent) of gram-positive cocci. A statistical analysis of patients' comorbidities revealed a significant difference in the proportion of patients with hypertension (31.3 percent with positive nitrite vs. 4.5 percent with negative nitrite, p < 0.05). The proportion of patients with positive nitrite who had fever was larger than patients with negative nitrite (75 percent vs. 43.2 percent respectively, p < 0.05). Nitrate-reducing Staphylococcus aureus showed high level resistance to ciprofloxacin (66.7 percent) in comparison with nitrite-negative isolates (100 percent sensitive). CONCLUSIONS: This preliminary study had shown that evaluation of clinical signs and symptoms, together with urinary nitrite result, could help physician to take important decisions.