Bacteriuria in patients with an orthotopic ileal neobladder: urinary tract infection or asymptomatic bacteriuria?

Abstract

OBJECTIVE To investigate the prevalence of asymptomatic bacteriuria (ABU) and urinary tract infection (UTI), and the local and systemic inflammatory response, in patients with ileal neobladder. PATIENTS AND METHODS The study included 40 patients who had a radical cystectomy and ileal neobladder. Two urine samples, one for chemical and physical analysis, and cytofluorimetry, and one for urine culture, were collected every 3 months for 9 months after surgery. RESULTS Of 119 urine cultures, 69 (57%) were positive for bacteria. Only nine of the 40 patients had no bacteriuria on urine culture. Escherichia coli strains were cultured from eight of 10 patients with persistently positive urine. The incidence of bacteriuria was different according to gender. There was a high concentration of leukocytes (0–6 µL) in 118 of 119 samples. The mean concentration of leukocytes in sterile urine culture was 1181/µL, while in patients with ABU the mean was 491 (P < 0.05). CONCLUSION A positive urine culture is a very common finding in patients with an orthotopic bladder. The most interesting results was the absence of elevated inflammatory indices and/or symptoms, even in those patients with high levels of bacteriuria. Probably this is due to the completely different inflammatory response of ileal mucosa against bacteria than has bladder mucosa. Indeed, the leukocyte concentration detected in urinary sediment was inversely association with bacterial growth in urine cultures. These findings suggest a redefinition of ABU and UTI in patients with an orthotopic neobladder.

Hygiene and urinary tract infections after cystectomy in 452 Swedish survivors of bladder cancer

“…In a search in PubMED (26 May 2009) with 'urinary bladder neoplasm', 'urinary tract infection' and 'urinary diversion' as search terms, 40 articles were found, but none reported hygiene as a possible predictor of UTI after cystectomy. The most common pathogenic organisms in patients with urinary diversions are Gram-negative [1][2][3]21] and studies indicate that soap-based hand washing fails to prevent Gram-negative bacteria transfer to catheters [22]. To our knowledge there is no evidence to support the belief that frequent hand-washing, showering or bathing in the bathtub influences the risk of symptomatic UTIs after cystectomy.…”

“…The prevalence of bacteriuria, intermittent or continuous, is high after cystectomy with urinary diversion for bladder cancer; 77-94% of patients after cystectomy have bacteria in the urine, irrespective of the type of urinary diversion [1][2][3][4]. About a quarter of patients with a urinary diversion contract a symptomatic UTI each year [5][6][7].…”

“…For a UTI to occur bacteria must be present, but the simple presence of bacteria does not necessarily cause the UTI [3]. Hygienic measures might lessen the concentration of bacteria but it is not known whether hygienic measures applied during emptying of urine from a urinary diversion decrease the risk of contracting a UTI in cystectomized patients.…”

“…For a UTI to occur bacteria must be present, but the simple presence of bacteria does not necessarily cause the UTI [3].…”

“…However, we could not confirm that hygienic practices were important in this situation. Most patients with a urinary diversion have bacteriuria but not all develop symptomatic UTIs needing treatment with antibiotics [2][3][4]7,21]. Bruce et al [2] described early yeast colonization of the ileal segment, used as a conduit, within 10 days after surgery.…”