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Introduction: The patients who undergo intermittent catheterization are at high risk of urinary tract infection. A prophylaxis method for this infection can be represented by the lubrication of urethral catheters with 0.1% gentamycin cream. This study compared the lubrication of urethral catheters with 0.1% gentamycin cream and 2% lidocaine jelly in relation to the quantitative results of the urine culture and incidence of symptomatic urinary tract infection and asymptomatic bacteriuria., Material and Methods: Sixteen patients, divided in groups A and B, were studied. Patients in Group A were directed to lubricate the urethral catheter with 0.1% gentamicin cream, whereas in Group B with 2% lidocaine jelly. Urine cultures and urine analysis were carried out every three weeks, for four months, for a total of 5 samples. The presence or absence of bacteria or fungi, the number of colonies and the isolated types, and the leukocyturia were evaluated., Results: No significant differences in the presence of significant bacteriuria, symptomatic urinary tract infection and asymptomatic bacteriuria were found between the two groups. Escherichia coli was the most common isolated bacterium in both groups., Conclusions: The results of this study, in line with previous works, showed that the lubrication of urethral catheters with 0.1% gentamicin cream is not an effective alternative to reduce significant bacteriuria and prevent urinary infection in patients who undergo clean intermittent catheterization.

Treatment of infections by beta-lactamase-producing microorganisms is very difficult. Our aim was to determine the in vitro susceptibility of 430 ESBL-positive Escherichia coli strains isolated from urinary tract infections. All the microorganisms were isolated in the Microbiology Unit at the Ospedale dell'Angelo in Mestre (Venice) between May 2008 and September 2009 and were confirmed by the double-disk test. All microorganisms were sensitive to imipenem and meropenem, 98.4% to tigecycline, 95.1% to amikacin, 89.3% to nitrofurantoin, 67.5% to gentamycin and 63.2% to piperacillin/tazobactam. Only 22.6% were sensitive to cotrimoxazole, while fluoroquinolone (norfloxacin and levofloxacin) activity was found to be very low (6%).

Antimicrobial susceptibility levels of Enterococcus faecalis isolated from urine were followed up at our University Hospital during three years (1999-2001), in order to evaluate the trend of antibiotic resistance of this common community-acquired pathogen of the genito-urinary tract. One thousand and 249 consecutive strains were examined, and a surprisingly low resistance profile was detected. As a result, penicillin , ampicillin, nitrofurantoin and piperacillin may still represent first-line agents in our area when community-acquired urinary tract enterococcal infections is of concern, pending in vitro susceptibility studies.

Bacteriological and systematic investigation has been carried on 135 confined to bed patients at the Neurological Department of the Policlinico of the University of Catania from January 1993 to June 1993, in order to estimate the frequency of the I.V.U. and the probable correlations with the basic nerve disease. Infections have been found with greater frequency between women and patients with catheter. The microorganisms most frequently isolated were: E. coli (36%) and Streptococcus faecalis (36%). Patients with positive urine culture have been treated in accordance with the indications of the bacterial identification. Particularly, surveys carried out in a group of patients suffering from cerebral stroke (81 cases), showed a frequent association between the I.V.U. and the beforesaid pathology. Similar results have been obtained in the two groups of patients submitted to 2 and to 3 drawings of urine respectively, practised at a distance of 5 of 5 days the one form the other.

In clinic practice urethral specimens from a big proportion of patients are inadequate or swabbing if not undertaken at all because for the discomfort experienced. Moreover, such an experience sometimes discourages patients for reattending. It is clear that having a urine sample from patients is incomparably preferable to having an inadequate urethral swab or none. 250 women attending our gynecology clinic had a urinary sample (20 ml first-voided urine minimum 4-hours from prior menstruation) analysed with an enzyme immunoassay (IDEIA-Dako) for the detection of Chlamydia trachomatis. They also had sample taken from cervix, and urethra for testing with IDEIA. The urinary samples, compared with urethral samples, showed a optimal correspondence to final results. It is concluded that the urinary samples could be used for screening programs to detect Chlamydia trachomatis.

A variation among the strains responsible of nosocomial infections was noted in the last years with a revival of Gram + bacteria. Coagulase-negative staphylococci assumed a great importance, particularly those resistant to methicillin. Staphylococcus epidermidis is now an important infective agent, especially in patients with prostheses or other devices. To value the impact of these microbiological variations on surgical patients, we studied data related to 1271 specimens from postoperative septic complication from 1980 to 1988. The incidence of Gram + strains in surgical infections was 46.8% in 1980-1983 period and 59.2% in 1984-1988 period with statistical significance (p less than 0.05).

Different strains of E. coli, that were isolated during years 1986-1990 from 217 urine samples in patients with asymptomatic bacteriuria, cystitis, cysto-pyelitis and pyelonephritis, appeared to be more frequently haemolytic (34.5%) than strains of E. coli isolated from faecal samples in patients with acute enteropathy. It was confirmed that the haemolysin production occurs during log -phase of bacterial growth. The degree of haemolysis can vary widely according to the strain involved. Agglutination tests, using 53 O-antiserum, showed a great variety of serogroups. Some of them (04, 018, 022) are prevalent among the haemolytic strains isolated from urine; some others (055, 0111, 075) are prevalent among the anhaemolytic strains isolated from urine and faeces.

Acute-and convalescent-phase sera from 22 children were examined by ELISA in comparison with a routine complement fixation (CF) test for detection of anti-CMV antibodies. All these subjects were excreting CMV from urine and/or saliva. The results showed that ELISA is more sensitive than CF test. Particularly ten children showed, by ELISA, anti-CMV antibody titers more agreeing with clinical-virological features. Generally, in other subjects the results of the two serological tests were similar. Three cases showed discordances both between the two methods and between serological data and clinical virological findings.

The authors report a their casuistry on 2155 between urinocultures and cultures of vescical catheters, pointing out an unexpected prevalence of Gram-positive germs and of that point out the possible causes. There are represented also some tables relative to the antibiotics tested for the single germs.

Since infections of the urinary tract in children often present diagnostic difficulties, it is essential to be able to identify these patients with simple, reliable methods. After a clinical-laboratory study on 4176 urine cultures, the Authors affirm that the reliability of this test is much greater when the parents have been instructed in the correct way of collection the urine specimen, and when in the laboratory the "slide" is carried out within three hours of taking the sample.

The percentages of positive cultures of mycobacteria obtained from sputum, bronchial-aspirate and urine treated with 0.2% Bactofen and with 0.5% Desogen were compared. Respiratory materials gave significantly higher values of these percentages when treated with Bactofen. Urine showed opposite results but these were not statistically significant. Isolates of MOTT too were more frequent in specimens decontaminated with Bactofen. Contamination rate showed no modifications.

On the grounds of published data and of those resulting from an investigation carried out in the Italian hospitals, the writers propose to standardize the requests for microbiological exams and the sampling procedures and the acquisition of the materials to be subjected to bacteriological examination.

From our data urinary tuberculosis, clearly reduced as regards past decennia, now results constant in annual number of cases. The reduced frequency sometimes requires some problems of differential diagnosis. After a few considerations about anatomo-pathologic aspects, we examine the diagnostic procedures starting from that urinary tuberculosis has not pathognomic clinical signs, except identification of M. tuberculosis in urine. The medical treatment consists in administering three drugs (rifampin, isoniazid, ethambutol) for 3 months and then two drugs for 6-9 months, on the ground of clinical course. Surgical treatment can be divided in destroying and preserving surgery. At last, endoscopic treatment takes aim at dilating ureteral stenoses.

Two microscopical screening methods have been used to assay the suitability of urine samples for automated direct antimicrobial susceptibility testing by the means of a "MS-2 Microbiology System" apparatus. Gram stained smears showed if specimens were monomicrobic and fresh-mount bacterioscopy gave information about presumptive counts to establish inoculum size. The results obtained by the automated method have been compared with those of the direct disk diffusion method and the classical Stokes method on a single isolated colony. The three systems were reliable and only 7% of specimens gave major discrepancies and 15% minor errors. The influence of each antibiotic drug and of each bacterial species on the discrepancies has been discussed. Direct susceptibility testing by MS-2 seems to be accurate and in the same time so fast (5-6 h vs. 18-24 h) to appear very useful in the rational guide of chemotherapy in the more severe UTI.

The Autobac MTS is a semiautomatic modular system for the screening of urine cultures and the execution of both antibiogram and MIC. The principle on which these tests are based is that of turbidimetry. In this note, the authors examine in detail the determination of MIC, that is based on utilisation of the regression lines equation. The method used by Autobac has a greater precision than the break-point method. This fact is mostly due to the possibility of standardizing inoculum. The authors conclude that, on the ground of their experience, the MIC method always some disagreement with the literature for the tested antibiotics (aminoglycosides).

We examined 300 stipes of leavens coming from various material. Among these we identified 264 brances belonging to Candida king, utilizing the test for pseudomicelio production. Combininb with this test that of clamidospore production, the auxonogramma, culture media, we arrived to the classification of the species: C. Albicans 71%, C. Tropicalis 15.8%; C. Pseudotropicalis 0.6%; C. Krusei 0.3% C. Parapsilosis 0.3%. An analysis of the experiments utilized for the classification of the kind, proved that the test of germination is the most simple, rapid and safe method of ascrive the branches belonging to Candida kind to Albicans species.

The immunofluorescente technique detecting antibody-coated bacteria for diagnosis of site of UTI has been applied to 52 urine samples coming from : 11 patients with clinical diagnosis of pylonephritis, 21 infections of the lower urinary tract, 8 asymptomatic bacteriurias and 2 samples of urine obtained directly by pyelocentesis. The technique confirmed to be specific and sensible: strongly fluorescent germs were observed only in samples coming from pyelonephritis or urine from pyelocentesis. Repeatedly, from single samples were isolated more bacterial strains; only one of them was present in significant quantity. The some observation has been made also in 5 patients clinically affected with P.N., where 2 strains were isolated from each sample. In only one sample both strains were fluorescent, white in the remaining 4 samples the strain present in insignificative quantity was fluorescent. These observations, rather than a double localization (pyelo-renal and lower urinary tract) with different aetiologic agents, were interpreted to be the outcome of repeated antibiotic treatments. It is possible that they could have reduced the fluorescent "bacterial load" of the pyelo-renal region under significant number, simultaneously facilitating the emergence of superinfecting germs at the level of the lower urinary tract. We discuss the therapeutic involvements for a proper antibiotic treatment and the usefulness of flanking the test at the quantitative urine culture.

The count of bacteria in fresh, unstained, uncentrifuged urine specimens, using a phase-contrast microscope, magnification X400, and a hemocytometer chamber, is a simple method to exclude urinary tract infection. The specificity of this method is 94%, while the sensibility is 66%. We exclude an urinary infection when the count is less than 5 bacteria/0.1 ml. If we add to bacteria the evaluation of pyuria, the sensibility of this method does not change. On the contrary what we observe is an increase of the false positives. Bacteria more easily identified in urine specimens are E. Coli and Klebsiellae; the bacterioscopy has confirmed respectively 82% and 100% of positive urinecultures. The corresponding values for Protei and Streptococci are 23% and 20% respectively. This method is very simple also for teaching; it requires only a few minutes and is inexpensive. Its most useful utilization is the exclusion of urinary tract infection when the concentration of bacteria in the urine is less than 5 bacteria/0.1 ml.

All those clinical, laboratory, radiological and radioisotopic elements of importance in the diagnosis of chronic pyelonephritis in internal medicine have been examined. Anamnestic indications of chronic pyelonephritis include previous infections episodes of the urinary ways, pain in the lumbar and suprapubic region and micturition disturbances. Less significant are objective findings such as pain at percussion of the lumber region, hypertension and possible signs of renal insufficiency. Important diagnostically among laboratory examinations are leucocyturia higher than 1,000.000 in 24 hours, a findings of leucocyte cylinders, bacteriuria higher than 100.000 per cc of urine and the observation of immunoantibodies covering bacteria isolated from the urine. X-ray and radioisotopic examinations are recognised as having considerable diagnostic usefulness. None of the clinical, laboratory, X-ray or radioisotopic findings is, however, strictly specific. Confirmation of a diagnostic suspicion is only possible when scrupulous accumulation of the most typical subjective and objective findings regarding the disease is accompanied by the positivity of diagnostic tests. The results of these tests must in all cases be assessed critically in the context of the clinical picture for, taken singly, they have no decisive value.

Non malformative long term urinary tract infections affect above all the female sex. The specific anatomic conditions explain only in part the predisposition for the female sex. Other determinants are the individual susceptibility and bacterial virulence. The authors studied 169 pediatric patients with recurrent urinary tract infections; of which 159 where females. The study of the blood group in 70 patients showed a net predominance of the groups B and AB. About one-third of the patients studied presented a scarce symptomatology or complete absence. The urodynamic study in 120 patients has revealed an abnormal pattern in more than 80% of the cases. According to the authors the abnormal urodynamic pattern is related to the long-term infection and is reversible in the cases which are curable. In about one-third of the cases with long-term infections which are resistent to the therapy, the cystoscopy has revealed a cystitis cystica. The study carried out by the authors permits precise indications on the specific tests that must be effectuated in this particular type of pathology and the indications of treatment.

Microbial maps were performed taking swabs from nose, pharinx, external auditory meatus, groin, vagina, sputum and urine cultures in 69 cases of acute leukaemia, in order: to assess the germs' incidence in an "open ward" department; to eliminate the most dangerous pathogens with local treatment or with a selective therapy without broad-specturm antibiotics; to check, in the 43 cases followed from onset, the changes occurring during the admission and the disease progression; to collect data for comparison with a "sterile" ward. The local decontamination had only a temporary effect. During the course of the disease new, particularly dangerous, pathogens were cultured. Blood cultures were positive in 15% of the patients with fever at the onset of the disease, and in 36.9% of the patients with fever during the disease progression. These values were virtually the same as those observed in the acute stage of C.M.L. (35.7%). In akute leukaemia E. coli (35%) was the most common, followed by P. aeruginosa (20%), Klebsiella (15%), S. alpha haemolyticus (10%) and others. There was little or no relationship between the germs in the maps and those in the blood cultures, though it must be remembered that no stool cultures were examined.

The Authors have planned a program in order to file and elaborate with a computer the results of urine cultures. From 8.600 specimens, about 86% were negative or doubtful. The data obtained from 1201 positive cultures were processed in order to state the absolute and relative frequency of the bacterial species isolated and their distribution according to their genera, antibiotic resistence, month and sex. Among the most representative species the pattern of antibiotic resistence was surveyed. E. coli shows very high frequency (38%). The frequency of Pseudomonas increases while staphylococci frequency decreases as compared with the previous statements of various Authors. The analysis of the antibiotic sensitivity spectrum of 534 specimens shows that about 50% of E. coli strains are sensitive to 10, 11 and 12 antibiotics and their pattern of resistence involves no more than 9 antibiotics; on the contrary more than 60% of Pseudomonas and Proteus rettgeri are resistant to 10, 11 or 12 antibiotics and at any rate to no less than seven. Enterobacter and Proteus mirabilis present an intermediate pattern of resistence.

Good results have been achieved through a comparative study carried out on a sample of 362 cultures in order to verify the attendibility of a new method of research on bacteriuria. The new Urotube system follows the theorical bases of dip-inoculum of a substratum of a medium of culture. The changes which were verified after the simultaneous use of the two methods on the same sample, were very slight and meaningless for the crossed calculation of the chi2. The second part of the research refers to the qualitative side and test out the bacterial species found out us the considered samples. There were no important varieties between the studies of the following AA. (Kass, Schito) and ours; most infectious processes have, as ethiological agents, gram-negative bacteria, named Enterobacteriacae, which are much more numerous than gram-positive bacteria. It seem however important to underline a slight change of this ratio; it was verified during our test, infact we recorded a percentage of gram-positive higher than the percentage recorded by Kass and Schito.

The effect of up to 6months antibacterial treatment on both urine culture and the presence of antibody-coated bacteria in the urinary sediment was examined in 15 patients with upper urinary-tract infection. At the end of the sixth month all the patients had sterile urine, while about one half still demonstrated antibody-coated bacteria in their sediment. Such a finding strongly suggests that urine culture is "per se" insufficient to exclude the presence of bacteria in the renal parenchyma, and that the evaluation of antibody-coated bacteria might be a better way to watch the effect of treatment in upper urinary-tract infections.

This work evaluates the presence of antibiotics in urine specimens and it points out the high incidence of patients, mainly hospitalized, for whom the urineculture is required in spite of the antibiotic therapy in course. The interference that the antibiotic, present in the urine, might cause in the evaluation of the bacteric concentration is discussed. The authors censure the nonobservance of enclosing the clinical-anamnestic form entirely filled, necessary for a correct microbiological evaluation.

A streep test has been employed for bacteriuria involving identification of nitrites in the urine and results are compared with those obtained with classical bacteriological techniques. Parallel performance of the nitrite test and urine culture showed that the latter cannot be replaced as far as diagnosis goes but it also proved the usefulness of the nitrite test for mass screening purposes.

The AA. make in evidence the role of the milk as carrier of Cytomegalovirus. The virus was isolated in the 23.5% of the 17 specimens of milk examinated within the first 48 hours from the delivery. The contemporary observation of the urins of the womans was negative.

Remarks are presented on the significance of yeasts found in urine samples. Initially an incidence of 4.5% and 4.7% was reported but more careful clinical and microbiological assessment in two later series revealed a 3.5% and 3.4% incidence of yeast-induced UTI. A very recent survey revealed yeast-induced UTI in 3.4% of inpatients and 0.35% of outpatients. The percentages refer to the total number of positive and negative samples examined. Finally risk factors and the distribution of these infections in terms of age, sex and hospital department are discussed.

The loop method permits determining of bacteriuria without the necessity for serial dilution, and with a precision greater than that of the dip inoculum test. Results indicate that the method allows us to establish the level of bacteria present in infected urine (approximately 10(5) germs/ml) quite precisely, and furnishes reliable evaluation of high levels. Due to the small quantity removed by the loop, the possible presence of strong concentrations of chemobiotics does not influence the results, as subinhibiting concentrations easily occur with diffusion.