Missed UTIs? “Enhanced cultures” suggest so

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The New World of the Urinary Microbiota in Women

In this paper Linda Brubaker and Alan Wolfe from the Loyola University, Chicago, reveal emerging evidence proving the healthy bladder is not sterile.  It shows the limitations of traditional tools used in the clinical setting to diagnose UTI, including dipsticks and urine cultures, and discusses the need to adopt new testing methods to detect previously unrecognised organisms that are likely responsible for patients’ symptoms.

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  Fallacies and Misconceptions in Diagnosing Urinary Tract Infection

An informative chapter by Professor James Malone-Lee, UCL, from the 2014 online book ‘Novel Insights into Urinary Tract Infections and their Management’.  It describes the deficiencies of gold standard UTI diagnostic tools, such as MSU culture and the urinary dipstick and the accepted set thresholds, which are proven to miss up to 50% of infections.  The article places emphasis on the importance of low-level microscopic pyuria and reported symptoms when making a diagnosis.


The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients with Lower Urinary Tract Symptoms without Acute Frequency and Dysuria

This study discredits the reliability of using urinary dipsticks and microscopic pyuria as diagnostic tools to ruleout UTI in patients with chronic lower urinary tract symptoms (LUTS).  The study concludes by calling for the abandonment of these as gold standard diagnostic tools.


Intracellular Bacterial Communities: A Potential Etiology for Chronic Lower Urinary Tract Symptoms

This review examines the emerging evidence of intracellular bacterial communities (IBC) in occult and recurrent UTI (due to invasion of the cells in the bladder wall and the formation of biofilm-like IBC) in patients with chronic LUTS and negative cultures.

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Filamentation by Escherichia coli subverts innate defenses during urinary tract infection

This paper demonstrates how during post-acute stages of infection, uropathogenic Escherichia coli (UPEC) can invade cells in the bladder wall to avoid innate defences (immune or antibiotic attack), where they form biofilm-like intracellular bacterial communities (IBC), and go on to colonise the surrounding epithelium and generate further IBC and quiescent intracellular reservoirs (QIRs).

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Importance of Biofilms in Urinary Tract Infections: New Therapeutic Approaches

This review examines the role biofilm plays in persistent UTI and prostatitis.  It discusses the difficulties in eradicating biofilm infections and looks at new therapeutic approaches, including nanoparticles, biofilm enzyme inhibitors, bacteriophages and low-energy surface acoustic waves and the urgent need for new antimicrobial drugs to inhibit bacterial virulence and biofilm formation.

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Uncomplicated UTI symptoms ‘almost always due to bacterial infection’

Almost all women presenting with typical symptoms of a urinary tract infection did have a bacterial infection, even when standard tests of their urine were negative, a study in Belgium found.

GP researchers found that although standard tests ruled out a bacterial infection in one fifth of the women, 98% of them tested positive using a DNA testing method.