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abstract

116 - PRESENCE OF BACTERIURIA AND UROPATHOGENIC BACTERIAL PROFILE ARE ASSOCIATED WITH URINARY TRACT SYMPTOMS IN PATIENTS PRESENTING FOR UROGYNECOLGIC EVALUATION

116

PRESENCE OF BACTERIURIA ANDUROPATHOGENIC BACTERIAL PROFILE ARE ASSOCIATED WITH URINARY TRACTSYMPTOMS IN PATIENTS PRESENTING FOR UROGYNECOLGIC EVALUATION

A. PEACHER-SEANEY1,A. B. WHITE 2, M. RIEGER 3, V. AGUILAR 4;
1Icahn Sch. of Med. at Mount Sinai, New York, NY,2Univ. of Texas at Austin, Austin, TX, 3DellMed. Sch. at the Univ. of Texas at, Austin, TX, 4UTSW atAustin, Austin, TX.

Introduction: Patientspresenting to a urogynecology clinic with symptoms of a urinary tractinfection often have voiding dysfunction and/or pelvic organ prolapseconfounding their clinical presentation. It is difficult to discernupon a patient’s initial presentation, if their voiding dysfunctionsymptoms are independent or incited by bacteriuria. In addition,demographics such as age are thought to increase a patient’s riskof bacteriuria. It is known that E coli. is a predominanturopathogen in uncomplicated urinary tract infections, however, if itelicits specific symptomatology distinct from other uropathogens isunknown.
Objective: To determine prevalence and riskfactors for significant bacteriuria in patients presenting for carein a urogynecology specialty clinic. Among patients with bacteriuriadifferences in symptom profile by bacterial species will becompared.
Methods: A retrospective chart review wasperformed on all patients presenting to the urogynecology specialtyclinic for initial evaluation between January 2012 and January 2015.Demographic data were collected. Patients were grouped by thepresence or absence of significant bacteriuria on screening culture,as defined by >100,000 cfu/mL. The overall prevalence ofbacteriuria along with risk factors for the presence of bacteriuriawas determined. Among patients with positive screening cultures, thepresence or absence of urinary tract symptoms including incompleteemptying (subjective feeling of incomplete voiding), nocturia (wakingone or more times at night to void), urgency/ frequency (8 or morevoids per day), stress urinary incontinence, urge urinaryincontinence, and mixed urinary incontinence was recorded todetermine the association between specific urinary tract symptoms andbacterial profile. Student’s t-test and multivariablelogistic regression model were used in statistical analysis todetermine the association between specific urinary tract symptoms andbacterial profile.
Results: 175 consecutive patients wereevaluated during the study period. The overall prevalence ofsignificant bacteriuria was 17%. Of positive urine cultures, themajority grew E. coli (63%), Klebsiella (13%), andCitrobacter (7%). Other bacteria were rare. Among 30 womenwith bacteria on urine culture, the mean number of symptoms was 2.50(SD 1.1) compared to 1.97 (SD 1.2) symptoms among 145 women withoutbacteria on urine culture (p = 0.03). The type of bacteria cultured(Gram-positive, Gram-negative, Atypical) could not be associated witha mean number of symptoms secondary to low sample numbers in somebacteria groups. Women with diabetes were 2.4 times (95% CI:1.01-5.75) more likely to have bacteria on urine culture compared towomen without diabetes, after adjusting for age, parity,postmenopausal status, and tobacco use. No other variables in themodel were statistically significantly associated with a positiveurine culture. Multivariable logistic regression model examiningassociations of age, parity, postmenopausal status, diabetes, andtobacco use with presence of any symptoms did not show anysignificant associations.
Conclusions: The prevalence ofbacteriuria in patients presenting for urogynecologic care issignificant at 17%, and the bacterial profile is consistent withpreviously published trials in an asymptomatic ambulatory population.Diabetic women are more susceptible to bacteriuria while tobacco use,age, and menopausal status do not increase the risk. The presence of2.5 or more specific symptoms is associated with an increasedlikelihood of infection and should be considered when evaluatingpatients. To improve the diagnosis and treatment of women presentingfor care, these conclusions should be taken into consideration whenevaluating women with urinary symptoms in a urogynecologyclinic.
References: Journal of Clinical Microbiology,Neurourology and Urodynamics, mBio.

Multivariablelogistic regression model examining associations of demographicsand bacteriuria

Variable

Bacteriuria>100,000 cfu/mL(OddsRatio)

95%CI

P-value

Age

0.995

0.944-1.050

0.87

Parity

0.885

0.704-1.112

0.29

Postmenopausalstatus

1.365

0.374-4.990

0.64

Diabetes

2.415

1.014-5.750

0.046

TobaccoUse

1.284

0.474-3.476

0.62