Poor predictive ability of urinalysis and microscopic examination to detect urinary tract infection.

Results of urinalysis, particularly the leukocyte esterase and nitrite tests, often are used to determine whether treatment is needed or a culture will be performed in cases of suspected urinary tract infection. However, there is disagreement over the quality of urinalysis as a screening test for urinary tract infections. Final urine culture results (n = 225) were obtained from the clinical microbiology laboratory. Stepwise binary logistic regression was used to derive a model using presence of infection as determined by culture as the dependent variable and urinalysis results as independent variables. A second set of data (n = 128) then was obtained to test the model. Statistical significance and the ability to predict infection based on urinalysis results were determined. Results indicated a lack of sensitivity for leukocyte esterase, nitrite, and presence of bacteria in the microscopic examination as indicators of urinary tract infection.

Demonstration of exopolysaccharide production by enterohemorrhagic Escherichia coli.

Enterohemorrhagic Escherichia coli O157:H7 produces visibly slimy colonies when grown on Sorbitol/MacConkey or Maloney's agar plates at room temperature, indicative of exopolysaccharide (EPS) production. Eighteen of 27 (67%) wild-type E. coli O157:H7 isolates produced enough EPS to be visually distinguishable. Of five strains that showed no visible EPS production on these media, four (80%) did produce slimy colonies on media containing higher salt concentrations. Measurements of EPS production by colorimetric determination of uronic acid indicated that EPS production was affected by growth temperature, atmosphere, and medium. Wild-type E. coli O157:H7 strain 932 produced the greatest amounts of EPS when grown anaerobically at 37 degrees C, whereas its plasmid-cured derivative 932P produced large quantities of EPS when grown aerobically at room temperature. Electron micrographs revealed thin, flexible fibers extending from the bacterial cell surface. Cells of strain 932P grown aerobically at room temperature were completely encased in a thick EPS matrix. Chemical analysis of purified EPS revealed that it is very similar or identical to colanic acid. E. coli O157:H7 adheres better to INT 407 cells when grown under conditions that favor high EPS production than when grown under conditions that repress EPS production.