Voided Midstream Urine Culture and Acute Cystitis in Premenopausal Women
Fundacion MF
Casi nadie lo hace pero lo reforzamos...
No está indicado urocultivo en el tratamiento de cistitis en mujeres premenopáusicas sanas.
¿Cómo hicieron el estudio?
Mujeres con cistitis no complicada.
Los autores tomaron cultivos a las mismas mujeres de la siguiente manera:
Primero les pedían muestras de urocultivo por chorro medio
luego,
les colocaban una sonda y tomaban muestras de urocultivo por sonda vesical.
Se encontró que la E coli sigue siendo la principal bacteria, incluso con recuentos bajos.
Hubo MUY POCOS cultivos donde creció enterococo y STC del grupo B con
la técnica del chorro medio, por lo que los autores llegan a la
conclusión de que probablemente estos gérmenes poco habituales NO causen
la cistitis por sí mismos.
http://www.nejm.org/doi/full/10.1056/NEJMoa1302186
Background
The
cause of acute uncomplicated cystitis is determined on the basis of
cultures of voided midstream urine, but few data guide the
interpretation of such results, especially when gram-positive bacteria
grow.
Methods
Women
from 18 to 49 years of age with symptoms of cystitis provided specimens
of midstream urine, after which we collected urine by means of a
urethral catheter for culture (catheter urine). We compared microbial
species and colony counts in the paired specimens. The primary outcome
was a comparison of positive predictive values and negative predictive
values of organisms grown in midstream urine, with the presence or
absence of the organism in catheter urine used as the reference.
Results
The
analysis of 236 episodes of cystitis in 226 women yielded 202 paired
specimens of midstream urine and catheter urine that could be evaluated.
Cultures were positive for uropathogens in 142 catheter specimens
(70%), 4 of which had more than one uropathogen, and in 157 midstream
specimens (78%). The presence of Escherichia coli in midstream urine was highly predictive of bladder bacteriuria even at very low counts, with a positive predictive value of 102
colony-forming units (CFU) per milliliter of 93% (Spearman's r=0.944).
In contrast, in midstream urine, enterococci (in 10% of cultures) and
group B streptococci (in 12% of cultures) were not predictive of bladder
bacteriuria at any colony count (Spearman's r=0.322 for enterococci and
0.272 for group B streptococci). Among 41 episodes in which
enterococcus, group B streptococci, or both were found in midstream
urine, E. coli grew from catheter urine cultures in 61%.
Conclusions
Cultures
of voided midstream urine in healthy premenopausal women with acute
uncomplicated cystitis accurately showed evidence of bladder E. coli but not of enterococci or group B streptococci, which are often isolated with E. coli
but appear to rarely cause cystitis by themselves. (Funded by the
National Institute of Diabetes and Digestive and Kidney Diseases.)
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