BACTERIURIA IN PATIENTS WITH A CONTINENT ILEAL RESERVOIR FOR URINARY-DIVERSION DOES NOT REGULARLY REQUIRE ANTIBIOTIC-TREATMENT

Objective To elucidate the importance of bacteriuria in patients with a continent urinary diversion. Patients and methods Eighteen asymptomatic patients (16 women and two men, with a mean age of 53 years [range 22-731) with ileal reservoirs coupled to the skin for urinary diversion were studied. Consecutive urine cultures were performed oner 5 months. Concomitant measurements of antibody titres against Escherichia coli and Proteus, and C-reactive protein (CRP) values were made. Results The results of the urine cultures varied considerably between samples. Increased titres of antibodies against E. coli were seen in several patients but the correlation with bacteriuria caused by E. coli was weak (sensitivity 33%, specificity 56%). Increased titres of antibodies against Proteus were rarely seen and in no patient correlated with bacteriuria caused by Proteus. Increased levels of CRP were seen in three patients. Conclusion The present results indicate that asymptomatic bacteriuria in patients with a continent ileal reservoir for urinary diversion is generally of no clinical importance and should not be treated with antibiotics. This conclusion is based on the observations that the bacterial strains growing in the reservoir changed spontaneously indicating colonization rather than infection. Raised titres of antibodies against E. coli correlated weakly with bacterial growth. The observed elevations in antibody titres were usually just above the normal upper limit.