agar and Urinary-Tract-Infections

Topics: Adult; Agar; Aged; Anti-Bacterial Agents; Bacteriological Techniques; Bacteriuria; Blood Urea Nitrogen; Clinical Trials as Topic; Culture Media; Drug Resistance, Microbial; Enterobacteriaceae; Escherichia coli; Female; Humans; In Vitro Techniques; Klebsiella; Male; Middle Aged; Neisseria; Proteus; Pseudomonas; Salmonella; Shigella; Staphylococcus; Streptococcus pneumoniae; Streptococcus pyogenes; Urinary Tract Infections

Animal models for host-microbial interactions have proven valuable, yielding physiologically relevant data that may be otherwise difficult to obtain. Unfortunately, such models are lacking or nonexistent for many microbes. Here, we introduce organ agar, a straightforward method to enable the screening of large mutant libraries while avoiding physiological bottlenecks. We demonstrate that growth defects on organ agar were translatable to bacterial colonization deficiencies in a murine model. Specifically, we present a urinary tract infection agar model to interrogate an ordered library of

Topics: Agar; Animals; Gene Library; Mice; Proteus mirabilis; Urinary Tract Infections

COVID-19 is the disease caused by SARS-CoV-2. The present hospital based study was performed to find out prevalence of Urinary Tract Infection among COVID 19 patients. The cross sectional study was performed with seven hundred fifty three laboratory confirmed COVID 19 cases over six months (from 1st July to 31st December, 2020). Urine samples collected from laboratory confirmed COVID-19 cases in appropriate sterile manner and were screened for pus cells and bacteria. This was followed by plating on Mac-conkey's agar media and 5% Sheep Blood agar media. Inoculated plates were incubated overnight in aerobic condition at 37°C. Discrete colonies were further studied by Gram staining, tests for motility, battery of biochemical tests. Antibiogram was performed by disk diffusion method as per CLSI guidelines. Species confirmation and MIC (Minimum Inhibitory Concentration) values of the tested antibiotics were detected by automation. Results were analyzed according to standard statistical methods. Ninety urine samples were culture positive (11.95%). Escherichia coli was found to be the commonest pathogen, isolated in forty three cases (47.78%) followed by Enterococcus faecalis in twenty nine (32.22%) and Klebsiella pneumoniae subspp. pneumonia in eighteen occasions (20%). Enterococcus faecalis isolates were sensitive to Vancomycin, Linezolid and Nitrofurantoin and nineteen isolates were resistant to fluroquinolones (65.51%). Majority of the Gram Negative isolates were susceptible to nitrofurantoin (80.32%) where as fifteen carbapenemase producers, thirteen AmpC Betalactamase producers and twenty one Extended Spectrum Beta Lactamase (ESBL) producers have been recorded. Constant awareness regarding the antibiotic guidelines for COVID-19 cases is the need of the hour.

Topics: Agar; Anti-Bacterial Agents; beta-Lactamases; COVID-19; Cross-Sectional Studies; Escherichia coli; Female; Humans; Male; Microbial Sensitivity Tests; Nitrofurantoin; Prevalence; SARS-CoV-2; Urinary Tract Infections

Proteus mirabilis (P. mirabilis) is a frequent cause of catheter-associated urinary tract infections. This study aims to investigate the anti-infective effect of Alhagi maurorum extract (AME), the traditional medicinal plant in the middle east, on the biofilm-forming P. mirabilis isolates. Hydroalcoholic extract and oil of A. maurorum were characterized by HPLC and GC-MS. The antiproliferative, anti-biofilm, and bactericidal activity of AME at various concentrations were assessed by turbidity, crystal violet binding, and agar well diffusion assays, respectively. The AME's effect on adhesion and quorum sensing (QS) were investigated by in vitro adhesion assay on cell culture and agar overlay assay using Janthinobacterium lividum (ATCC 12472) as a biosensor strain. In addition, the expression level of selected genes involved in QS and biofilm regulation were determined by quantitative Real-Time PCR. Furthermore, the bladder phantom model was created to evaluate the assays and investigate the catheter's calcium deposition. The most effective chemical compounds found in AME were tamarixetin, quercetin, and trans-anethole. Although AME did not inhibit swarming motility, it reduced biofilm production and exerted a concentration-dependent anti-adhesive and anti-QS activity against P. mirabilis. AME also downregulated the expression level of selected genes involved in biofilm formation and QS. This study showed that AME as a natural compound reduced biofilm formation of P. mirabilis by targeting virulence factor genes, quorum sensing, and other strategies that include preventing the adhesion of P. mirabilis to the cells. The results suggest that A. maurorum extract might have the potential to be considered for preventing UTIs caused by P. mirabilis.

Topics: Agar; Anti-Bacterial Agents; Bacterial Adhesion; Biofilms; Catheters; Fabaceae; Humans; Phytotherapy; Plant Extracts; Plants, Medicinal; Proteus mirabilis; Quorum Sensing; Urinary Tract Infections; Virulence

Topics: Agar; Ampicillin; Animals; Anti-Bacterial Agents; Biofilms; Drug Resistance, Bacterial; Ertapenem; Escherichia coli Infections; Female; Imipenem; Meropenem; Norfloxacin; Saudi Arabia; Sheep; Urinary Tract Infections; Uropathogenic Escherichia coli; Virulence Factors

Uropathogenic Escherichia coli (UPEC) is the primary cause of urinary tract infections (UTIs) in animals and humans. We applied Transposon-Directed Insertion Site sequencing (TraDIS) to determine the fitness genes in two well-characterized UPEC strains, UTI89 and CFT073, in order to identify fitness factors during UTI in a pig model. This novel animal model better reflects the course of UTI in humans than the commonly used mouse model, and facilitates the differentiation between sessile and planktonic UPEC populations. A total of 854 and 483 genes in UTI89 and CFT073, respectively, were predicted to contribute to growth in pig urine, and 1257 and 764, were scored as required for colonization of the bladder. The combined list of fitness genes for growth in urine and cystitis contained 741 (UTI89) and 439 (CFT073) genes. The essential genes for growth on LB agar media supplemented with kanamycin and the fitness factors during growth in human urine were also analyzed in CFT073. A total of 457 essential genes were identified and the pool of fitness genes for growth in human urine included 215 genes. The gene rfaG, which is involved in lipopolysaccharide biosynthesis, was included in all the fitness-gene-lists and was further confirmed to be relevant for all the conditions tested regardless of the host and the strain. Thus, this gene may represent a promising target for the development of new therapeutic strategies against UTI UPEC-associated. Besides this important observation, the study revealed strain-specific differences in gene-essentiality as well as in the fitness-gene-repertoire for growth in human urine and UTI of the pig model, and it identified novel factors required for UPEC-induced UTIs.

Topics: Agar; Animals; Disease Models, Animal; Escherichia coli Infections; Escherichia coli Proteins; Humans; Kanamycin; Lipopolysaccharides; Mice; Swine; Urinary Tract Infections; Uropathogenic Escherichia coli

Disease detection through gas analysis has long been the topic of many studies because of its potential as a rapid diagnostic technique. In particular, the pathogens that cause urinary tract infection (UTI) have been shown to generate different profiles of volatile organic compounds, thus enabling the discrimination of causative agents using an electronic nose. While past studies have performed data collection on either agar culture or jellified urine culture, this study measures the headspace volume of liquid urine culture samples. Evaporation of the liquid and the presence of background compounds during electronic nose (e-nose) device operation could introduce variability to the collected data. Therefore, a headspace gas chromatography-mass spectrometry method was developed and validated for quantitating ethanol in the headspace of the urine samples. By leveraging the new method to characterize the sample stability during e-nose measurement, it was revealed that ethanol concentration dropped more than 15% after only three measurement cycles, which equal 30 minutes for this study. It was further shown that by using only data within the first three cycles, better accuracies for between-day classification were achieved, which was 73.7% and 97.0%, compared to using data from within the first nine cycles, which resulted in 65.0% and 81.1% accuracies. Therefore, the newly developed method provides better quality control for data collection, paving ways for the future establishment of a training data library for UTI.

Topics: Agar; Electronic Nose; Ethanol; Gas Chromatography-Mass Spectrometry; Humans; Urinary Tract Infections; Volatile Organic Compounds

The urinary tract infection (UTI) is a prevalent infection that affects people of all ages. Bacterial agents are the most common causes of UTIs.

Topics: Agar; Amikacin; Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Ciprofloxacin; Citrobacter koseri; Gentamicins; Humans; Imipenem; Levofloxacin; Microbial Sensitivity Tests; Urinary Tract Infections

Several strains of

Topics: Adolescent; Adult; Agar; Anti-Bacterial Agents; Biofilms; Child; Escherichia coli; Escherichia coli Infections; Female; Heat-Shock Proteins; Humans; Male; Urinary Tract Infections; Virulence; Young Adult

This study evaluates whether the rapid fosfomycin resistance (fosfomycin NP) method can be used for detecting fosfomycin resistance in routine laboratory work. Results from the disk diffusion and rapid fosfomycin NP methods were compared with the reference agar dilution method for Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections. The study included 57 E. coli and 48 Klebsiella spp. isolates from urinary tract infections. The reference agar dilution and disk diffusion methods were performed in accordance with EUCAST recommendations, and the results were evaluated according to EUCAST V.10.0. The method developed by Nordmann et al. was used for rapid detection of fosfomycin resistance (Nordmann, P., Poirel, L., Mueller, L., 2019. Rapid Detection of Fosfomycin Resistance in Escherichia coli. J Clin Microbiol. 57(1), e01531-18. doi:https://doi.org/10.1128/JCM.01531-18). The acceptable categorical agreement (CA ≥ 90%) and the rates of major error (ME <3%) and very major error (VME < 3%) of the two methods were compared with the reference method according to the criteria of ISO 20776-1. Fosfomycin resistance was detected in 15.8% of E. coli and 75% of Klebsiella spp. isolates using the reference method. Disk diffusion method showed CA 89.5%, ME 12.5% in E. coli isolates, and CA 75%, ME 100% in Klebsiella spp. isolates. No VME was detected in both methods. The rapid fosfomycin NP method resulted in CA 96.4%, ME 0.0%, VME 22.2% in E. coli isolates, and CA 77.3%, ME 81.8%, and VME 3% in Klebsiella spp. isolates. We believe the results from both of disk diffusion assay and rapid fosfomycin NP for the E. coli and Klebsiella spp. isolates are incompatible with the reference method and should not be used as an alternative to the agar dilution method.

Topics: Agar; Anti-Bacterial Agents; Diagnostic Tests, Routine; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Fosfomycin; Humans; Klebsiella; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Urinary Tract Infections

Rapid and accurate identification of pathogens involved in urinary tract infections helps to guide antimicrobial therapy. Chromogenic agars provide presumptive identification directly from primary isolation media. They have been intended to make the bacterial isolation and identification process easier and faster. Our study aimed to compare the performance and the cost of the CPS ID3® and the Uriselect4® chromogenic agars with the conventional method for the isolation and identification of urinary tract infections bacteria. We included 301 urinary samples in a prospective study conducted in May 2018 in the clinical laboratory of the National institute of nutrition and food technology of Tunis. Isolates from routine media were identified using API® system while isolates from chromogenic media were directly identified by colony color with reference to the manufacturer's recommendations. Chromogenic media yielded more pure positive cultures and allowed better isolation of Escherichia coli, Klebsiella pneumoniae, Citrobacter koseri, Morganella morganii and Streptococcus agalactiae. Sensitivity and specificity of the presumptive identification of most commonly isolated uropathogens were higher with the Uriselect4® medium than with the CPS ID3® medium. Chromogenic media yielded the identification of pathogenic organisms 24 hours sooner than the conventional method in approximately 63 % of cases with the CPS ID3® medium and in 77.7% of cases with the Uriselect4® medium. Chromogenic media allowed a much better isolation of bacteria commonly involved in urinary tract infections with a quick, easy and accurate presumptive identification especially with the Uriselect4® medium.

Topics: Agar; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Bacteriological Techniques; Chromogenic Compounds; Culture Media; Diagnostic Tests, Routine; Female; Humans; Male; Microbial Sensitivity Tests; Sensitivity and Specificity; Urinalysis; Urinary Tract Infections

The recent introduction of Full Laboratory Automation systems in clinical microbiology opens to the availability of streams of high definition images representing bacteria culturing plates. This creates new opportunities to support diagnostic decisions through image analysis and interpretation solutions, with an expected high impact on the efficiency of the laboratory workflow and related quality implications. Starting from images acquired under different illumination settings (top-light and back-light), the objective of this work is to design and evaluate a method for the detection and classification of diagnostically relevant hemolysis effects associated with specific bacteria growing on blood agar plates. The presence of hemolysis is an important factor to assess the virulence of pathogens, and is a fundamental sign of the presence of certain types of bacteria.. We introduce a two-stage approach. Firstly, the implementation of a highly accurate alignment of same-plate image scans, acquired using top-light and back-light illumination, enables the joint spatially coherent exploitation of the available data. Secondly, from each segmented portion of the image containing at least one bacterial colony, specifically designed image features are extracted to feed a SVM classification system, allowing detection and discrimination among different types of hemolysis.. The fine alignment solution aligns more than 98.1% images with a residual error of less than 0.13 mm. The hemolysis classification block achieves a 88.3% precision with a recall of 98.6%.. The results collected from different clinical scenarios (urinary infections and throat swab screening) together with accurate error analysis demonstrate the suitability of our system for robust hemolysis detection and classification, which remains feasible even in challenging conditions (low contrast or illumination changes).

Topics: Agar; Algorithms; Bacteria; Electronic Data Processing; Hemolysis; Humans; Lighting; Models, Statistical; Programming Languages; Reproducibility of Results; Signal Processing, Computer-Assisted; Software; Urinary Tract Infections

The aim of this study was to evaluate the usefulness of chromogenic media for isolation of bacteria from urine and direct identification of UTI pathogens. A total of 100 urine specimens were inoculated on blood agar and MacConkey agar as a reference method and on the following media to be tested: chromID® CPS® Elite (CPSE, bioMérieux), CHROMagarTM Orientation (BioMaxima), BD CHROMagar Orientation Medium (ORI, Becton Dickinson), CHROMagarTM Orientation (ORIE, Graso) and Brillance UTI Clarity Agar (UTI C, Oxoid). After a 24-hour incubation period, 47 Gram-positive cocci and 62 Gram-negative rods were observed. The specificity and sensitivity of all chromogenic media was 97.3% and 93.5% respectively for qualitative diagnostic; and 81.9% and 81.3% respectively for semi-quantitative diagnostic. The mean PPV and NPV of the chromogenic media were 98.7% and 87.7% for qualitative UTI diagnostic, and 90.9% and 71.9% respectively for semi-quantitative diagnostic.

Topics: Agar; Bacteria; Bacterial Infections; Chromogenic Compounds; Colony Count, Microbial; Culture Media; Escherichia coli; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Sensitivity and Specificity; Urinary Tract Infections

Chromogenic media (CM) are available for urine specimens (US) to enable rapid identification of common urinary tract pathogens (UTP). Two CM, chromID™ CPS (CPS4) agar (bioMérieux, St. Laurent, QC) and UriSelect™ 4 (URS4) agar (Bio-Rad, Montreal, QC), were compared to the standard media (SM) for the isolation and identification of UTP. Over a 10-day period, US were inoculated to CPS4, URS4, and SM (BAP and MAC). CM interpretation was done according to the product inserts by one person blinded to the results of SM. SM were read by experienced technologists according to protocol and isolates were identified using BD Phoenix™. The results were grouped into significant (SG), mixed (MG), and no significant growth (NSG). A total of 903 US were studied. SM identified 239 SG, 112 MG, and 552 NSG cultures. The most common pathogens were Escherichia coli (38 %) and Enterococcus spp. (11 %). Comparing CM to SM, the exact agreement was 89.3 and 89.5 % for URS4 and CPS4, respectively. When grouped by clinical significance, agreement with SM was 93.0 and 93.1 % for URS4 and CPS4, respectively. CM were equivalent with respect to processing time. Advantages include decreased need for automated identification of certain species, particularly E. coli. In terms of workflow, CM enables same-day identification for almost 50 % of significant UTP. Overall, both CM compared well to SM and allowed for rapid preliminary identification of many UTP.

Topics: Agar; Bacteriological Techniques; Canada; Chromogenic Compounds; Culture Media; Enterococcus; Escherichia coli; Female; Humans; Male; Middle Aged; Time Factors; Urinary Tract; Urinary Tract Infections

Because of their widespread diffusion and impact on human health, early identification of pathogens responsible for urinary tract infections (UTI) is one of the main challenges of clinical microbiology. Currently, bacteria culturing on Chromogenic plates is widely adopted for UTI detection for its readily interpretable visual outcomes. However, the search of alternate solutions can be highly attractive, especially in the rapidly developing context of bacteriology laboratory automation and digitization, as long as they can improve cost-effectiveness or allow early discrimination. In this work, we consider and develop hyperspectral image acquisition and analysis solutions to verify the feasibility of a "virtual chromogenic agar" approach, based on the acquisition of spectral signatures from bacterial colonies growing on blood agar plates, and their interpretation by means of machine learning solutions. We implemented and tested two classification approaches (PCA+SVM and RSIMCA) that evidenced good capability to discriminate among five selected UTI bacteria. For its better performance, robustness and attitude to work with an expanding set of pathogens, we conclude that the RSIMCA-based approach is worth to be further investigated in a clinical usage perspective.

Topics: Agar; Humans; Urinary Tract Infections

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae strains are frequent causative agents both in community-acquired infections and in nosocomial infections. The newly developed ChromID ESBL agar (bioMerieux, Marcy I'Etoile, France) is a chromogenic medium that helps rapid identification of ESBL-positive Enterobacteriaceae species from the clinical samples. The aim of this study was to evaluate the performance of ChromID ESBL agar in the rapid identification of ESBL-positive pathogens from the urine samples of the patients with urinary tract infections. A total of 672 urine samples (437 outpatients, 235 inpatients) were included in the study. All of the samples were inoculated simultaneously to 5% sheep blood agar, McConkey agar and ChromID ESBL agar media, and evaluated after incubation at 37°C for 18-24 hours. Gram-negative pathogens were tested for ESBL both by the standard combined double-disk diffusion (CDD) method using ceftazidime and cefotaxime disks and by doubledisk synergy (DDS) test. Among 672 urine cultures, 199 yielded microbial growth in routine media (sheep blood agar and/or McConkey agar), whereas 57 yielded bacterial growth in ChromID ESBL agar. When CDD method was accepted as the reference method according to Clinical and Laboratory Standards Institute (CLSI) recommendations, the sensitivity, specificity, positive and negative predictive values for ChromID ESBL agar for the detection of ESBL-positive bacteria in urinary tract infections were estimated as 97%, 92.9%, 89.1%, and 98.1%, respectively. Additionally, we also discovered that Chrom ID ESBL agar could detect vancomycin-resistant enterococci (VRE) as well as ESBL-positive bacteria, in our study. In order to investigate this observation we inoculated a total of 203 stock strains of Enterococcus spp. (118 vancomycin-sensitive, 85 vancomycin-resistant) to this medium. None of the vancomycinsensitive Enterococcus spp. did grow in ChromID ESBL medium, while 83 of the 85 resistant isolates (97.6%) did grow in the medium. As a result, it was concluded that ChromID ESBL agar medium was advantageous since it led to the growth of VRE and ESBL-positive Enterobacteriaceae isolates in different colors and helped in early identification of these two problematic bacteria. We thought that especially early detection of VRE will accelerate the establishment of necessary measures to prevent the nosocomial spread of this microorganism.

Topics: Agar; beta-Lactamases; Culture Media; Enterobacteriaceae; Enterobacteriaceae Infections; Enterococcus; Urinary Tract Infections; Urine; Vancomycin Resistance

Catheter-associated urinary tract infection (CAUTI) is the most common device-associated infection and can result in serious medical consequences. We studied the efficacy of a novel microscopic physical surface modification (Sharklet) for preventing bacterial colonization and migration of uropathogenic Escherichia coli on silicone elastomer.. In vitro growth assays evaluated E coli colonization using three variations of micropatterned silicone surfaces vs a smooth silicone control. Enumeration techniques included quantification of colonies on surfaces and analysis of bacterial area coverage and colony size. In vitro migration assays involved placement of micropatterned and smooth silicone rod segments between two agar islands to measure incidence of migration.. All three variations of the Sharklet micropattern outperformed the control surfaces in inhibiting E coli colonization. On average, 47% reduction in colony-forming units (CFUs) and bacterial area coverage plus 77% reduction in colony size were achieved with the Sharklet surfaces in tryptic soy broth and artificial urine compared with the control nonpatterned surfaces. The incidence of E coli migration over the rod segments was reduced by more than 80% for the Sharklet transverse patterned rods compared with the unpatterned control rods.. The Sharklet micropattern is effective at inhibiting colonization and migration of a common uropathogen. This performance is achieved through a physical surface modification without the use of any antimicrobial agents. Because deterrence of bacterial colonization and migration is a critical step to prevent CAUTI, the Sharklet micropattern offers a novel concept in addressing this important problem.

Topics: Agar; Colony Count, Microbial; Humans; Movement; Prosthesis-Related Infections; Risk Factors; Surface Properties; Urinary Catheterization; Urinary Tract Infections; Uropathogenic Escherichia coli

Urinary tract infections are common clinical problems in children, even though lots of treatment strategies have been tried. Many studies of the application of probiotics for urinary tract infection in female adults exist, but there is a lack of studies in children. The aims of this study were to screen probiotic strains for inhibiting the uropathogens in vitro, to find candidates for in vivo study. Nine strains of E. coli were isolated from children with urinary tract infection and six uropathogens were obtained from Korean Collection for Type Cultures and American Type Culture Collection. Also 135 lactic acid bacteria (LAB) strains were isolated from healthy children, and were identified through physiologic, biochemical methods, 16S rDNA PCR, and data analysis. And with agar disk diffusion assay technique the antimicrobial activities of these LAB strains against those uropathogens were examined. Three strains of separated LAB strains demonstrated major antimicrobial activity against all the uropathogens. In the agar disk diffusion assay technique, antimicrobial activities increased most in the 4th day culture broth with separated Lactobacillus. In summary, some LAB can be used as candidates to develop the probiotic microorganisms that inhibit uropathogens in children, and are expected to be applied to treatment and prevention of pediatric urinary tract infection.

Topics: Agar; Anti-Infective Agents; Child; Culture Media; Diffusion; Escherichia coli; Feces; Humans; In Vitro Techniques; Korea; Lactic Acid; Microbial Sensitivity Tests; Polymerase Chain Reaction; Probiotics; RNA, Ribosomal, 16S; Urinary Tract Infections

Chromogenic agars have been developed to recognize frequently occurring microorganisms directly on primary cultures, thus reducing the daily workload in a clinical microbiology laboratory. We compare two chromogenic agars, CHROMagar Orientation (CO) and CPS ID 3 (CPS3), with routine media (biplate technique using trypticase soy blood agar and eosin methylene blue agar) for the isolation, enumeration and identification of organisms in urinary tract infection (UTI).. The clinical significance of the urine samples was categorized as probable UTI, possible UTI, no UTI (negative), or contaminated according to the culture result. Discrepancy analysis with the categories of minor error, major error and very major error was used to compare the culture media.. Of 1386 urine specimens, the consistencies in clinical significance of CO and CPS3 to routine media were 90.7% and 89.8%, respectively. For the enumeration of microorganisms, 524, 514, and 521 clinically significant isolates were isolated on routine media, CO, and CPS3, respectively. Of the 524 significant isolates on routine media, results for 473 and 474 isolates agreed on CO and CPS3, respectively. Approximately 91.9% of Escherichia coli and 100.0% of Enterococcus spp. could be identified directly on CO media, while 97.5% of E. coli and 94.4% of Enterococcus spp. could be identified on CPS3 media.. The use of CO and CPS3 as single media is promising for clinical urine culture.

Topics: Agar; Bacteria; Bacteriological Techniques; Chromogenic Compounds; Culture Media; Enterococcus; Escherichia coli; Humans; Urinary Tract Infections; Urine

To compare the performance of a new chromogenic medium, Uriselect 4, with cystine lactose electrolyte deficient (CLED) agar and an established chromogenic agar, CPS ID 2 medium, for detection of urinary tract pathogens.. Using a semiquantitative culture method, 777 samples were inoculated on to the three test media in duplicate. All bacterial strains that yielded a potentially significant growth were observed for colony colour and identified using standard methods.. Of the 777 samples tested, 589 urine samples yielded potentially significant growth of at least one strain. A total of 811 strains were isolated on at least one of the three media. A total of 168 urine samples yielded a mixture of at least two strains. Uriselect 4 medium showed the best sensitivity of the three media and only failed to recover 14 strains (1.7%). CPS ID 2 medium failed to recover 22 strains (2.7%). CLED medium showed the worst recovery and failed to recover 74 strains (9.1%). Both chromogenic media allowed for identification of Escherichia coli with a high degree of specificity (98% for Uriselect 4, 99.7% for CPS ID 2). Inclusion of a spot indole test increased the specificity of both chromogenic media to 100% for E coli.. Uriselect 4 and CPS ID 2 were superior to CLED medium for the isolation of urinary tract pathogens mainly because of their ability to discriminate mixed cultures. Both chromogenic media were also useful for the preliminary identification of the most common urinary tract pathogens.

Topics: Agar; Bacteria; Bacteriological Techniques; Chromogenic Compounds; Culture Media; Humans; Sensitivity and Specificity; Urinary Tract Infections

To comparatively assess the performance of three chromogenic agar plates, CPS ID2, Chromogenic UTI, and USA, for the detection and enumeration of all urinary tract pathogens and the direct identification of Escherichia coli, Proteus mirabilis and Enterococcus spp.. Two hundred and forty-three urine specimens prospectively collected from hospitalized patients were randomly inoculated in parallel on the three media.. Of the 243 urine specimens, 235 yielded positive cultures, of which 151 were pure cultures and 84 were mixed cultures. CPS ID2, Chromogenic UTI and USA agar gave detection rates of 99.1%, 97.1% and 96.6%, respectively. The main difference in non-detection between CPS ID2 agar and the two new media concerned Staphylococcus spp. strains. Based on the total number of strains detected (n = 348), the total identification rates of E. coli, P. mirabilis and Enterococcus spp. on CPS ID2 agar, Chromogenic UTI agar and USA agar were 60.3%, 61.2% and 59.2%, respectively.. The detection rates and identification rates of the three media were very close and only minor differences were noted. The lower detection rates for Chromogenic UTI and USA were mainly due to their lesser ability to support growth of Staphylococcus spp.

Topics: Agar; Bacteria; Chromogenic Compounds; Colony Count, Microbial; Culture Media; Enterococcus; Escherichia coli; Evaluation Studies as Topic; Humans; Proteus mirabilis; Urinary Tract; Urinary Tract Infections; Urine

As part of the UK antimicrobial resistance strategy and action plan, the Public Health Laboratory Service (PHLS) is required to collect antibiotic susceptibility data so that resistance trends and patterns can be monitored. Most laboratories report urine Gram negative isolates, as "coliforms" according to morphological appearance, but without an acceptable identification system the antimicrobial surveillance data will be meaningless. Commercially available identification systems tend to be expensive and time consuming. Chromogenic agars, which claim to improve the detection of mixed cultures and identification of organisms from urine, have now become available and may provide a cost effective alternative. The primary aim of this study was to compare the performance of cystine lactose electrolyte deficient (CLED) agar with a chromogenic agar (Oxoid urinary tract infection medium; CUTI) in terms of isolation rates and ability to detect mixed cultures. Secondary aims were to evaluate the correlation of "presumptive" identification of isolates from chromogenic media with that of two commercial identification systems and to appraise the sensitivity of the semiquantitative loop and filter paper strip culture techniques.. One thousand, four hundred and sixty six urine samples were examined in four laboratories using the semiquantitative culture methods of 1 microl loop and filter paper strip. The degree of accuracy of organism identification was measured by comparing the presumptive identification using colony colour supplemented with simple bench tests, with identification obtained from two more complex commercial systems.. There was no significant difference between the performance of the loop and filter paper strip methods on the CLED agar, but the CUTI agar performed significantly better than the CLED agar for the detection of significant isolates and mixed cultures. This difference was greater using the loop method. Identification of the organisms using the commercial systems gave > 99% agreement and was therefore considered suitable as a standard against which to compare the presumptive CUTI identification. Using the manufacturer's colony colour criteria in combination with a bench indole test, the CUTI medium was 99% specific for Escherichia coli, although this was reduced to 97% if the indole test was omitted. Citrobacter spp were the most commonly misidentified organisms, giving false presumptive identification as E coli. By testing oxidase activity to differentiate Pseudomonas spp and the absence of indole production to support the identification of Proteus mirabilis, the CUTI medium provided a suitable identification for 86.8% of Gram negative isolates. The remaining 13.2% would require further identification.. CUTI medium improves the detection of mixed cultures, thereby improving the reliability of reporting of significant isolates when compared with CLED agar. When supplemented with simple bench tests it provides an identification system capable of speciating 86.8% of Gram negative isolates and providing a valuable cost effective mechanism for antimicrobial resistance surveillance.

Topics: Agar; Bacterial Typing Techniques; Chromogenic Compounds; Colony Count, Microbial; Culture Media; Drug Resistance, Bacterial; Enterobacteriaceae; Humans; Urinary Tract Infections; Urine

Using the comparison method, we have evaluated the technical performance of Uricult Trio by culturing on Uricult Trio and agar plates. Urine samples (477) from patients in primary healthcare were cultured in parallel in a microbiology laboratory. The result for Uricult Trio evaluated using the comparison method was incorrect in 32% of the cultures. We also studied the performance of Uricult Trio when used in primary healthcare by using external control panels. External control panels consisting of Uricult Trio, inoculated with known concentrations of certain bacterial strains, were used to assess the performance of Uricult Trio in primary healthcare during the period 1993-7. Aberrations in reports of concentration have ranged from 10% to 33%, failure in reporting of mixed culture from 0% to 91% and reporting of E. coli from 15% to 86%. There has been no sign of improvement over the years. The results indicate that Uricult Trio is unsuitable for indications other than exclusion of urinary tract infection or diagnosis of urinary tract infection caused by E. coli. Further, there is need for quality assurance and training activities at primary healthcare laboratories, probably best carried out in collaboration with local clinical microbiology laboratories.

Topics: Agar; Colony Count, Microbial; Culture Media; Escherichia coli Infections; False Negative Reactions; Female; Humans; Male; Point-of-Care Systems; Quality Control; Reagent Kits, Diagnostic; Reproducibility of Results; Sweden; Urinary Tract Infections

This study evaluates the effect of training on the results from Uricult Trio and an established urine culture when used at primary healthcare laboratories in two Swedish counties, Uppsala and Värmland. Urine cultures and dipslides, Uricult Trio, performed at these laboratories were interpreted a second time at central laboratories. Interpretation errors at the primary healthcare laboratories were calculated. Primary healthcare laboratories also received external control panels with urine cultures and dipslides. There was one study period each year for 3 years in Uppsala and for 2 years in Värmland. A training programme was completed between study periods in Värmland. In Uppsala, primary healthcare laboratory results could be reviewed, as interpretations by the central laboratory were returned to them. The main outcome measures were the percentage of interpretation errors which, in the first study period, was 33-39%. This dropped to 15-19% in the second study period. In the results from the external control panels there were no striking differences between the studied areas and Sweden as a whole, except that Uppsala showed a better result in reporting E. coli and failed in 10% compared to Sweden 46%. A method for both quality assessment and education is to ask the primary healthcare laboratories to send cultures to the central laboratory for interpretation requesting their return to the primary healthcare laboratory with the interpretation from the central laboratory attached.

Topics: Agar; Bacteriuria; Colony Count, Microbial; Escherichia coli Infections; Female; Humans; Male; Point-of-Care Systems; Primary Health Care; Quality Control; Reagent Kits, Diagnostic; Research Design; Sweden; Urinary Tract Infections

The cell surface hydrophobicity (CSH) is a non-specific adhesion factor that is important in the proliferation of microorganisms on solid surfaces. Serratia spp. is a bacterium that has been increasingly implicated as a primary pathogen in numerous human infections, particularly in urinary tract infections. CSH of 60 Serratia spp. strains isolated from clinical materials was evaluated using the ammonium sulfate salt aggregation test. Bacteria were grown for 24 h and 48 h at room temperature (22 degrees C) and 37 degrees C on enrichment broth and agar (Biomed), enrichment agar with 5% human blood and medium composed of agar granulated (Becton Dickinson), neopeptone (Difco) and 1% (v/v) glycerol. CSH was estimated most frequently when the analyzed strains in enrichment broth were cultured. When grown in enrichment broth cells of Serratia spp. at room temperature were more hydrophobic (43% after 24 h and 47% after 48 h) than those at 37 degrees C (30% after 24 h and 33% after 48 h). CSH of the examined Serratia spp. strains were depended on the temperature, time of the culture of bacteria and the kind of media. The influence of the culture conditions on the changes in CSH of the analyzed bacteria may suggest significance of these properties in the pathogenesis of Serratia spp.

Topics: Agar; Bacterial Adhesion; Bacteriological Techniques; Humans; Serratia; Species Specificity; Surface Properties; Temperature; Urinary Tract Infections

Five chromogenic agar plates--CPS ID2 medium (bioMérieux, France), CHROMagar Orientation medium (Becton Dickinson, France), UriSelect3 medium (Sanofi Diagnostics Pasteur, France), Rainbow Agar UTI medium (Biolog, USA) and Chromogenic UTI medium (Oxoid, Germany)--for the detection, enumeration and direct identification of urinary tract pathogens were compared using 443 urine specimens at two hospital laboratories. The enumeration of microorganisms was consistent on the five media for 403 of the 477 (84.5%) microorganisms. Chromogenic UTI, CPS ID2, UriSelect3, CHROMagar Orientation and Rainbow UTI gave detection rates of 98.3%, 97.9%, 97.3%, 96.9% and 94.1%, respectively, with some problems in yeast growth occurring on Rainbow UTI agar and problems in Staphylococcus spp. growth occurring on UriSelect3. For the direct identification of Escherichia coli, sensitivities were 93.8%, 88.5%, 86.1% and 82.2% for CHROMagar Orientation, CPS ID2, UriSelect3 and Rainbow UTI, respectively. Chromogenic UTI medium did not allow the accurate identification of Escherichia coli, since the indole reaction cannot be applied to this medium. Depending on the media, Enterococcus spp. could be identified at the genus or the species level. Slight differences were detected in the presumptive identification of the Proteus-Morganella-Providencia group and the Klebsiella-Enterobacter-Serratia group. Additionally, on Rainbow UTI agar, 12 of 20 Klebsiella pneumoniae strains and two of nine Pseudomonas aeruginosa strains were correctly identified. In conclusion, CPS ID2 medium and CHROMagar Orientation medium showed similar performance overall, while the UriSelect3, Rainbow UTI and Chromogenic UTI media require some improvement.

Topics: Agar; Bacteria; Candida; Chromogenic Compounds; Colony Count, Microbial; Culture Media; Evaluation Studies as Topic; Humans; Urinary Tract Infections; Urine

CHROMagar Orientation, a new chromogenic medium, was evaluated for the detection and differentiation of gram-positive and gram-negative pathogenic microorganisms in 900 urine samples from hospitalized patients. Performance characteristics of the medium were evaluated in comparison to those of 5% sheep blood and MacConkey agars by direct inoculation of the urine samples on the three media. Four gram-negative and two gram-positive strains as well as one yeast control strain from the American Type Culture Collection were used to ensure quality control. CHROMagar Orientation succeeded in detecting all the urine pathogens that were detected by the reference media, including gram-negative bacilli, staphylococci, streptococci, and yeasts. Colony color and morphology on CHROMagar Orientation accurately differentiated Escherichia coli, Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa, and Acinetobacter spp. Owing to the similarity in the pigmentation produced by Klebsiella, Enterobacter, and Citrobacter isolates, the medium failed to distinguish among them; however, these isolates were easily recognized as coliforms because of their metallic blue coloration. Staphylococci were clearly perceptible: S. aureus and S. epidermidis grow in regular-size colonies that range from opaque white to yellowish, and S. saprophyticus produces opaque pink colonies. All streptococcus strains, including those from groups B and C, were detected. They grow as undifferentiated flat dry diffused colonies, and additional tests were required for identification. Enterococci were easily discriminated by their strong turquoise pigmentation and their typical growth on the agar's surface. Yeast grow in typical creamy wet convex colonies. The accuracy of antibiotic susceptibility determinations according to standard methods was also tested by picking isolates directly from CHROMagar Orientation. The results showed excellent correlation with those obtained with microorganisms picked from reference media. Owing to the ease in differentiating mixed flora on CHROMagar Orientation, antimicrobic susceptibility tests were performed directly from primary isolates in all cases without the need for subcultures.

Topics: Agar; Bacteria; Humans; Urinary Tract Infections

The microbiological performance of BBL CHROMagar Orientation medium and CPS ID2 agar was compared to that of Columbia agar with 5% sheep blood and MacConkey agar without crystal violet for the enumeration and presumptive identification of bacteria responsible for urinary tract infections. Of a total of 658 clinical urine specimens, 118 specimens yielded no growth, 402 specimens yielded growth with cell counts of > or = 10(5) CFU/ml, and 138 specimens yielded growth with cell counts of < 10(5) CFU/ml. Of the specimens with cell counts of > or = 10(5) CFU/ml, 163 were pure cultures and 239 were mixed cultures. A total of 266 Escherichia coli organisms were isolated on both chromogenic media, 260 were isolated on blood agar, and 248 were isolated on MacConkey agar. One strain (0.4%) failed to develop the expected pink color on CHROMagar Orientation medium, and 23 strains (8.7%) failed to develop the expected pink color on CPS ID2 agar. Enterococci (CHROMagar Orientation medium, n = 266; CPS ID2 agar, n = 265) produced small blue-green colonies on both chromogenic media. Fifty of the mixed cultures contained enterococci that were detected only on the chromogenic media. The Klebsiella-Enterobacter-Serratia (KES) and the Proteus-Morganella-Providencia (PMP) groups could be identified on both chromogenic media. Of 66 isolates of the KES group, 63 grew with the expected color on CHROMagar Orientation medium and 58 of 64 isolates grew with the expected color on CPS ID2 agar. Other microorganisms required further identification. The use of chromogenic medium formulations offers a time-saving method for the reliable detection, enumeration, and presumptive identification of urinary tract pathogens. One of the greatest advantages of these media is the easy recognition of mixed cultures.

Topics: Agar; Bacteria; Bacteriological Techniques; Bacteriuria; Culture Media; Enterobacter; Enterobacteriaceae; Escherichia coli; Humans; Klebsiella; Proteus; Providencia; Serratia; Urinary Tract Infections

The aim of the study was to evaluate the chromogenic agar plate CPS ID2 (bioMérieux) and determine its cost-benefit ratio.. A total of 2,193 urinary sediments were processed. The urine culture was carried out in CPS ID2 agar and in cystine-lactose electrolyte deficient (CLED) agar, when needed. Identification of the microorganisms was performed following standard microbiologic procedures through biochemical tests prepared in our laboratory. The identification, from CPS ID2 agar, by direct detection in medium of four metabolic activities: beta-glucuronidase, beta-glucosidase, deaminase, and indol production, was performed following to manufacturer's instructions.. A total of 289 urine cultures were positive, 18 were negative and 34 were contaminated samples. The identification, directly performed from the colonies detected in CPS ID2 agar, was correct in 96% of 166 Escherichia coli, in 92% of 24 Proteus mirabilis and in 97% of 38 enterococci. CPS ID2 agar exhibited 94% and 100% sensitivity and specificity, respectively in E. coli identification, 92% and 100% in P. mirabilis and 97% and 99% in Enterococcus. The use of this new media, CPS ID2, in our laboratory, implies a budgetary increment. However, if commercial galleries are used for routine identification, the cost will be reduced using this new media.. The CPS ID2 agar allows the isolation and direct identification of the most frequent urinary tract pathogens: E. coli, P. mirabilis and Enterococcus in primary isolation medium. Using this medium, bacteriologists will be able to save time and reagents when identifying the most common uropathogens. Furthermore, the use of this medium would reduce costs in some laboratories.

Topics: Agar; Amino Acid Oxidoreductases; Bacterial Proteins; Bacteriological Techniques; beta-Glucosidase; Candida albicans; Candidiasis; Chromogenic Compounds; Cost-Benefit Analysis; Culture Media; Enterobacteriaceae; Enterobacteriaceae Infections; Evaluation Studies as Topic; Glucuronidase; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Indoles; L-Amino Acid Oxidase; Urinary Tract Infections; Urine

A new commercial agar (Uricult-Trio) with 8-hydroxyquinoline-beta-glucuronide was used to assess 2,536 uropathogens for beta-glucuronidase activity typical of Escherichia coli. Included in the study were 1,807 strains of the family Enterobacteriaceae, 284 strains of nonfermentative bacilli, 345 strains of gram-positive cocci, and 100 yeast strains. In identifying E. coli, the test agar gave a sensitivity of 95.5% and a specificity of 97.2%. Fifty E. coli isolates gave negative reactions; 31 non-E. coli strains produced black colonies characteristic of E. coli. No growth of gram-positive cocci and no false-positive reactions from yeasts were observed. The recovery rate for E. coli on this agar was at least 10% higher than that on blood agar.

Topics: Agar; Bacteriological Techniques; Bacteriuria; Diagnostic Errors; Escherichia coli; Escherichia coli Infections; Evaluation Studies as Topic; Humans; Hydroxyquinolines; Quinolines; Sensitivity and Specificity; Urinary Tract Infections; Urine

This study evaluated the performance of CPS ID2 (bioMérieux) compared to that of conventionally used selective agar for the identification of bacteria responsible for urinary tract infections. This medium detects bacterial enzymes using chromogenic substrates. Two hundred and nineteen samples of urine were tested in order to evaluate new CPS ID2 in comparison to blood agar and MacConkey agar. According to our results, the CPS ID2 agar is an easy, rapid and sensitive method for the screening of colonies suspected of being Escherichia coli, reducing the number of biochemical tests needed. Also, enterococci and Proteae can be easily detected. Other micro-organisms require further identification. The greatest value of this medium is the accurate identification of polymicrobial cultures.

Topics: Agar; Chromogenic Compounds; Enterobacteriaceae; Enterococcus; Escherichia coli; Humans; Sensitivity and Specificity; Urinary Tract Infections

The piliation and hemagglutination properties of 54 consecutive Escherichia coli isolates from women with recurrent urinary tract infections were studied. Mannose-sensitive hemagglutination (MSHA) of guinea pig erythrocytes, characteristic of type 1-piliated bacteria, was produced by 75% of the isolates, 32% produced mannose-insensitive hemagglutination, and 14% produced no hemagglutination reaction. The production of type 1 pili was examined in those strains that produced MSHA only. Studies with antiserum prepared against purified pili suggested that at least three subtypes of type 1 hemagglutinins were represented among the isolates. All of the type 1-piliated isolates produced MSHA after serial subculture in static broth. After growth on agar, selected type 1-piliated isolates were subdivided into two groups. Many strains apparently suppressed piliation during growth on agar (regulated variants); all colonies became MSHA negative and were composed of nonpiliated cells as shown by electron microscopy. The loss of the MSHA phenotype often occurred after a single overnight passage on agar, and any remaining hemagglutinin was gradually lost with one to three additional passages. Seven strains, however, retained a significant hemagglutination titer after multiple subcultures on agar, and they produced colonies consisting of a mixed population of piliated and nonpiliated cells. These strains were apparently able to oscillate between states of pilus expression and nonexpression during growth on agar (random phase variants). When nonpiliated cells isolated from the mixed, random variant population were plated on agar, they gave rise to hemagglutination-positive colonies that consisted of both piliated and nonpiliated cells. The distinction between random variants and regulated variants was also observed in shaking broth cultures inoculated with nonpiliated cells. The random variants produced MSHA-positive cultures composed of piliated and nonpiliated cells, whereas the regulated strains remained nonpiliated. The results indicate that type 1 pili are a predominant adhesin of uropathogenic E. coli and that during growth on agar only about one-fourth of the type 1-piliated isolates regulate pilus expression by random phase variation.

Topics: Agar; Culture Media; Escherichia coli; Female; Fimbriae, Bacterial; Hemagglutinins; Humans; Mannose; Morphogenesis; Urinary Tract Infections

A blood isolate of Pseudomonas aeruginosa was encountered which produced, on subculture to Mueller-Hinton agar, markedly adherent, tenacious colonies which were characterized microscopically by the presence of serpentine rows of interlocking bacilli. Factors accounting for the observed morphologic aberration, which was lost upon subculture, remain unknown.

Topics: Agar; Child, Preschool; Female; Humans; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Urinary Tract Infections

A total of 219 urine specimens were Gram stained and inoculated onto 5% sheep blood, eosin methylene blue and chocolate agars. Culture and smear results were evaluated to determine if the Gram stain and chocolate agar culture yielded further meaningful information. Additional information was gained in 42 (19%) of the specimens; however, most of the results were not considered significant. The analysis suggests that a Gram stain and/or chocolate agar culture is not warranted for routine urine culture set-up.

Topics: Agar; Bacteria; Haemophilus; Humans; Staining and Labeling; Urinary Tract Infections; Urine

One hundred strains of group B streptococci isolated from human infections were tested for growth on dip-slides available for the culture of urine. All grew on CLED agar, and none grew on MacConkey agar. The colonies were barely or not at all visible to the naked eye after overnight incubation (diameter, around 0.1 mm). The colony size increased eith prolonged incubation, but not if the inoculum density exceeded 10(6)/ml. Differences were found between lots of dip-slides. Poor growth on dip-slides may explain why group B streptococci have received little attention as pathogens of the urinary tract. The dip-slide screening personnel of one laboratory were informed of the experimental findings, and they started the practice of frequent subculture and prolonged incubation. The proportion of group B streptococci in significant bacteriuria increased from 0 to about 2% of positive cultures, whereas there was no conmitant increase of group B streptococci in dip-slides screened in several other laboratories serving as controls.

Topics: Agar; Bacteriological Techniques; Humans; Streptococcal Infections; Streptococcus agalactiae; Urinary Tract Infections; Urine

Topics: Agar; Ampicillin; Bacteria; Cephalexin; Dicloxacillin; Drug Combinations; Drug Synergism; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Urinary Tract Infections

The frequency of symptomatic and unapparent bacteriuria in infants and children of preschool age is estimated to be 1 to 2%. Ca. 5% of all girls and less than 0.5% of all boys between the ages of 6 and 19 years undergo bacteriuria. Women suffer from it to 5 to 15% during pregnancy and diabetics of about 10 to 20%. The sensitivity and specificity of different screening processes are evaluated with reference to numerous publications. It appears that the agar slide, which is in use all over the world, is markedly superior to all other methods with respect to price, handling and sensitivity, The only weakness of this method is frequent failure in the presence of inhibitors in the urine sample.

Topics: Adolescent; Adult; Agar; Aged; Bacteriuria; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Infant; Infant, Newborn; Male; Mass Screening; Middle Aged; Pregnancy; Serologic Tests; Urinary Tract Infections; Urine

Topics: Agar; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Urinary Tract Infections

Topics: Agar; Ampicillin; Bacteriological Techniques; Cacao; Child, Preschool; Chloramphenicol; Culture Media; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Pyuria; Urinary Tract Infections; Urine

Topics: Agar; Aged; Biochemical Phenomena; Biochemistry; Culture Media; Escherichia coli; Escherichia coli Infections; Female; Humans; Hydrogen Sulfide; Iron; Urinary Tract; Urinary Tract Infections

Topics: Agar; Escherichia coli; Humans; Klebsiella; Microbial Sensitivity Tests; Nitrobacter; Proteus mirabilis; Pseudomonas aeruginosa; Staphylococcus; Sulfamethoxazole; Trimethoprim; Urinary Tract Infections

Several new methods for detection of bacteriuria were studied to evaluate their usefulness as screening procedures. A new filter paper device incorporating dehydrated media and tetrazolium was found to be reliable when compared with the standard pour plate method in the laboratory and with the dip-slide method in a field test. It failed to detect yeasts and slowly growing streptococci. Antibiotics blocked the test when susceptible organisms were present. An agar-cup method was found to be quite reliable, but could be improved by use of differential media. The Griess test was confirmed in a small trial to be highly specific when used in conjunction with a first morning specimen, but of little value with random specimens. Phenzopyridine was found to give false positive reactions. The subnormal glucose test, although highly sensitive and specific, gave too many false positive tests to be useful other than as a screening method.

Topics: Agar; Anti-Bacterial Agents; Bacteriological Techniques; Bacteriuria; Diagnosis, Differential; Evaluation Studies as Topic; False Positive Reactions; Female; Filtration; Glycosuria; Humans; Indicators and Reagents; Methods; Tetrazolium Salts; Urinary Tract Infections

Topics: Agar; Bacteria; Bacteriological Techniques; Bacteriuria; Catalase; Culture Media; Diagnostic Errors; Humans; Nitrites; Tetrazolium Salts; Urinary Tract Infections

Topics: Agar; Diagnosis, Differential; Erythroblastosis, Fetal; Exchange Transfusion, Whole Blood; Female; Glucosephosphate Dehydrogenase Deficiency; Humans; Hyperbilirubinemia; Infant, Newborn; Jaundice, Neonatal; Kernicterus; Phenobarbital; Phototherapy; Pregnancy; Urinary Tract Infections; Virus Diseases

Topics: Agar; Anti-Infective Agents; Folic Acid Antagonists; Humans; Methods; Microbial Sensitivity Tests; Pyrimidines; Sulfamethoxazole; Trimethoprim; Urinary Tract Infections

Topics: Acridines; Agar; Animals; Blood; Conjugation, Genetic; Disease Models, Animal; Escherichia coli; Genes; Genetics, Microbial; Glucose; Guinea Pigs; Hybridization, Genetic; Keratoconjunctivitis; Mucous Membrane; Sheep; Shigella; Species Specificity; Urinary Bladder Diseases; Urinary Tract Infections; Virulence

Topics: Acetates; Agar; Bacteriological Techniques; Citrates; Fluorescence; Gluconates; Humans; Hydrochloric Acid; Iron; Klebsiella; Male; Porphyrins; Sodium; Solvents; Ultraviolet Rays; Urinary Tract Infections

Topics: Agar; Anti-Bacterial Agents; Culture Media; Hospitals; Humans; Methods; Microbial Sensitivity Tests; Staphylococcal Infections; United Kingdom; Urinary Tract Infections

Topics: Administration, Oral; Adolescent; Adult; Agar; Aged; Candidiasis; Cephalosporins; Escherichia coli; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Klebsiella; Klebsiella Infections; Male; Microbial Sensitivity Tests; Middle Aged; Nausea; Proteus; Proteus Infections; Staphylococcal Infections; Streptococcal Infections; Streptococcus; Streptococcus pneumoniae; Streptococcus pyogenes; Urinary Tract Infections; Vulvovaginitis

Topics: Acute Disease; Adult; Agar; Aged; Amides; Anti-Bacterial Agents; Escherichia coli; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Shigella; Staphylococcus; Streptococcus; Urinary Tract Infections

Topics: Adolescent; Agar; Bacteriological Techniques; Bacteriuria; Child; Child, Preschool; Culture Media; Female; Humans; Infant; Infant, Newborn; Male; Methods; Urinary Tract Infections

Topics: Agar; Bacteria; Bacteriuria; Diagnosis, Differential; Female; Humans; Methods; Urinary Tract Infections

Topics: Agar; Bacteriuria; Culture Media; Humans; Methods; Microscopy; Urinary Tract Infections; Urine

Topics: Agar; Female; Humans; Male; Methods; Plastics; Sex Factors; Specimen Handling; Time Factors; Urinary Tract Infections

Topics: Agar; Humans; Immunologic Tests; Precipitin Tests; Pyelonephritis; Urinary Tract Infections