Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancer study.

BACKGROUND: Controversy exists on whether urinary tract infection (UTI) is a risk factor for urinary bladder cancer (UBC). Here, the association is investigated using data from one of the largest bladder cancer case-control studies worldwide. METHODS: Information on (i) history and age at onset of regular cystitis ('regular low-UTI') and (ii) number and age at onset of UTI treated with antibiotics ('UTI-ab') from 1809 UBC patients and 4370 controls was analysed. Odds ratios (ORs) and 95% confidence intervals (CI) adjusted for age, education, smoking, and use of aspirin/ibuprofen were generated, for men and women separately. RESULTS: Regular low-UTI was associated with an increased UBC risk (men: OR (95% CI) 6.6 (4.2-11); women: 2.7 (2.0-3.5)), with stronger effects in muscle-invasive UBC. Statistically significant decreased risks (ORs ∼0.65) were observed for up to five UTI-ab, specifically in those who (had) smoked and experienced UTI-ab at a younger age. In women, UTI experienced after menopause was associated with a higher UBC risk, irrespective of the number of episodes. CONCLUSIONS: Regular cystitis is positively associated with UBC risk. In contrast, a limited number of episodes of UTI treated with antibiotics is associated with decreased UBC risk, but not in never-smokers and postmenopausal women.

Relation of sputum colour to bacterial load in acute exacerbations of COPD.

BACKGROUND: When COPD patients present with an exacerbation, one cannot verify a bacterial cause of an exacerbation without time-consuming laboratory analyses. This makes it difficult to decide up front if antibiotic treatment is needed. Therefore, in clinical practice sputum colour and purulence are often used. OBJECTIVE: To determine whether sputum colour and purulence, assessed by the Stockley colour chart, correlated with overall bacterial load in COPD patients admitted for an exacerbation. To check the robustness of the colour and purulence assessment, we correlated the changes in these parameters and the corresponding change in bacterial load in sputum over the first seven days of hospitalisation. METHODS: Twenty-two COPD patients admitted to the hospital for an exacerbation were included. During the first seven days daily sputum samples were collected. RESULTS: A very weak association between bacterial load and sputum colour was found. There was no difference in bacterial load between patients with purulent sputum or not. Also, no consistent relationship between change in sputum colour and change in bacterial load during admission was found. CONCLUSIONS: The very weak association between bacterial load and sputum colour confirms concerns over the usefulness of the colour chart. The distinction between purulent and mucoid sputum at exacerbation is insufficient for distinction between patients who are likely to benefit from antibiotic therapy and those who are not. Complementary studies are needed to determine which other, easily measurable factors can be used as predictors for an indication for use of antibiotics; sputum colour is not the one.