Ann Intern Med. 1993 Sep5;119(6):454-60.
A reassessment of the importance of "low-count" bacteriuria in young women
with acute urinary symptoms. Department of Internal
Medicine, Ohio State University, Columbus 43210-1240. To determine whether a statistical association exists between "low-count"
bacteriuria (> 10(2) to 10(4) colony-forming units/mL) and acute urinary
symptoms in young women. Prospective, case-control study. Gynecology clinic at a student health center. Women with or without urinary or vaginal symptoms. History of urinary infections and sexual activity. Quantitative
determination of bacteriuria and pyuria and bacterial species; urine leukocyte
esterase test; specific gravity; creatinine levels; vaginal leukocytes; and
in-vitro culture of urine. The Frequency of recent sexual activity, pregnancies, and contraceptive
practices was not statistically different between women with acute urinary
symptoms and asymptomatic controls. Escherichia coli and Staphylococcus
saprophyticus were the only microorganisms statistically associated with urinary
symptoms and pyuria (P< 0.001). Low counts of these organisms were found in
10.2% of asymptomatic women. As the bacterial count increased, the association
between these organisms and symptoms increased, and a step-wise increase
occurred in the Frequency and magnitude of pyuria, but the specific gravity and
urine creatinine levels remained unchanged. Escherichia coli, even at low
counts, grew well in the patients' own urine. Pyuria (> 20 leukocytes/mm3) was
present in 19.6% of asymptomatic women and was associated with vaginal
leukorrhea. "Low-count" bacteriuria was statistically more frequent among young women
with urinary symptoms than among asymptomatic controls. The low counts could not
be explained by dilution of the urine or failure of the bacteria to grow well in
the patients' urine. These findings suggest that the infection was not
established in the bladder urine and that "low-count" bacteriuria might be an
early phase of urinary tract infection. Please click on the required question. Thank
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