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Anaerobic Bacteria in Routine Urine Culture

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Anaerobic Bacteria in Routine Urine Culture J Clin Pathol: first published as 10.1136/jcp.19.6.573 on 1 November 1966. Downloaded from J. clin. Path. (1966), 19, 573 Anaerobic bacteria in routine urine culture JOHN T. HEADINGTON AND BARBARA BEYERLEIN From the Department ofPathology, the University of Michigan, and the Department of Microbiology in the University ofMichigan Medical Center, Ann Arbor, Michigan, U.S.A. SYNOPSIS One hundred and fifty-eight anaerobic organisms from 147 patients were isolated from 15,250 consecutive clean mid-stream or catheter urine specimens. The pathogenicity ofthe anaerobic genera commonly isolated from urine is reviewed and discussed. Failure to establish anaerobic isolates as pathogens and a paucity of reported cases proving anaerobic bacteria as significant causes of urinary tract infection permitted discontinuation of anaerobic culture as part of the routine screening procedure for investigation of urinary tract infections. Qualitative and quantitative urine cultures, as in 3 % CO2, but did grow anaerobically producing very screening tests in the laboratory diagnosis of urinary small, round, slightly raised, translucent or transparent tract infection, have become well-established pro- colonies, regarded as Bacteroides species. This group of cedures. To most studies have in- organisms was not further identified. date, however, Non-sporulating Gram-positive rods of characteristic vestigated the recovery of aerobic bacteria. This morphology which produced poor to slight growth in report summarizes the results of our attempt to iso- thioglycollate broth and no growth within 48 hours on copyright. late and identify anaerobic organisms. Anaerobic 5 % human blood agar, incubated in 3 % carbon dioxide bacteriuria is assessed for clinical significance. or under anaerobic conditions, were classified as Lacto- bacillus species. MATERIALS AND METHODS All Gram-positive cocci were subcultured to 5 % human blood agar plates and incubated aerobically, SPECIMENS Routine cultures were done on 15,250 capneically, and anaerobically for 48 hours. The Gram- consecutive clean mid-stream or catheter urines received cocci which in the Clinical Microbiology Laboratory of the University positive grew only under anaerobic conditions were identified either as Peptostreptococcus species or http://jcp.bmj.com/ Hospital from April 1962 to April 1965. Specimens were Peptococcus species on the basis of morphological received from both in-patient and out-patient units; how- characteristics after Gram-staining of thioglycollate ever, no attempt was made to separate specimens by cultures and on the presence or absence of catalase pro- source. Clinical records from 147 patients, representing duction. Species characterization was not done. 158 anaerobic isolates, were reviewed for evidence of Catalase-negative Gram-positive rods growing anaero- urinary tract infection and the possible pathogenic role bically were considered to be Clostridia. The majority of of anaerobic bacteria. these organisms were further characterized specifically on the basis of routine tests. on September 27, 2021 by guest. Protected TEST METHODS In evaluating large numbers of routine One hundred and ninety-five of 15,250 consecutive cultures, test methods were simplified to provide generic anaerobic urine cultures yielded one or more anaerobic rather than specific identification. isolates. Of these 62, or 32%, of anaerobic isolates were One-tenth millilitre of undiluted well-mixed urine was present in pure culture. inoculated directly into 9 9 ml. of thioglycollate broth. Although mixed anaerobic and aerobic cultures pre- Inoculated tubes were incubated at 37°C. and examined dominated, there were only rare instances of more than daily for macroscopic growth for a maximum of eight one anaerobic organism isolated per specimen. These days. All tubes revealing growth or questionable growth results are summarized in Table I. were Gram-stained and inspected for cellular morphology Table II indicates the frequent occurrence of anaerobic and Gram-reaction. genera in routine urine culture. Lactobacillus species All Gram-negative bacilli were subcultured on were in the majority followed by the Clostridial group. MacConkey's agar for aerobic incubation at 37°C., on Bacteroides, Peptostreptococcus, and Peptococcus species 5% human blood agar for incubation in 3% carbon together composed less than 16 % of the total. dioxide at 37°C. The Gram-negative variably pleo- The ratio of isolation of anaerobes in females as morphic rods, which failed to grow on MacConkey's agar compared to males, 3-7/1-0, is at variance with the usual in 24 hours, did not grow on blood agar within 48 hours University Hospital in-patient out-patient ratio of about Received for publication 20 June 1966. 1 -0/1-0. Although this indicates the greater likelihood of 573 J Clin Pathol: first published as 10.1136/jcp.19.6.573 on 1 November 1966. Downloaded from 574 John T. Headington and Barbara Beyerleii TABLE I 50- ISOLATION OF ANAEROBIC BACTERIA FROM ROUTINE CULTURE z LACTO BACILLURIA Total Percentage 40- Nos. Total DIABETES MELLITUS Cultures studied 15,250 Anaerobic isolates 195 1 3 30 Anaerobes isolated in pure culture 62 0-404 Anaerobes isolated in mixed culture 133 09 0 m 20 TABLE II mE FREQUENCY OF ISOLATION OF ANAEROBIC GENERA Speciies Pure MiAxsed Total Percentage 10 Total Lactobacillus 39 67 106 54 6 Clostridium 5 52 57 29 3 0' Bacteroides 5 9 14 7.3 MALES Peptostreptococcus 7 4 1 5.7 FEMALES Peptococcus 6 0 6 3.1 FIG. 1. Lactobacilliiria and diabetes mellitl.s. recovering an anaerobe from females, the nearly ubi- reports of clostridial infections of soft tissues of the quitous presence of anaerobic lactobacilli in the female pelvis and retroperitoneum, no example of primary genital tract after the menarche and before the meno- infection of the urethra, urinary bladder, ureter, or pause appears to be primarily responsible for this difference. kidney was found. On occasion, however, the initial locus of infection becomes a moot point because wounds in these structures offer a suitable portal of DISCUSSION copyright. entry to contiguous tissue. Nevertheless, in the absence of surgical or traumatic wounds, Clostridial LACTOBACILLUS Lactobacillus species have rarely been proved primary pathogens. However, anaerobic infections of the urinary tract must be considered stains causing pulmonary abscess (Korttila, 1953) rare. (single case) and subacute bacterial endocarditis Clostridial species were the second most common have been described. anaerobes isolated. Members of this genus accounted (Marschall, 1938) (single case) for 29 3 of all anaerobic isolates. Fifty-one of 57 No example of urinary tract infection due to anaero- % were as bic Lactobacillus species has been reported. isolates classified Clostridium perfringens; http://jcp.bmj.com/ One hundred and six strains of anaerobic Lacto- one as Clostridium septicum; and one as Clostridium sporogenes. Four could not be further identified. bacilli were isolated in this study, 39 in pure culture In this study there were no specific infections of the and 67 in mixed culture. No attempt was made to differentiate human vaginal strains. urinary tract which could be directly attributed to these organisms. A single non-fatal case of post- The clinical records for patients with pure lacto- operative clostridial septicaemia occurred following bacilluria were reviewed, and in no instance could transurethral resection of the prostate gland without an anaerobic Lactobacillus be incriminated on September 27, 2021 by guest. Protected species evidence of pelvic infection. as a urinary tract pathogen. Twenty-two of 53 iso- lates from mixed cultures were associated with BACTEROIDES Bacteroides species, said to out- clinical findings suggestive of urinary tract infection. number Escherichia coli as normal flora of the gastro- The remainder were recovered from asymptomatic intestinal tract are, however, infrequent pathogens. patients. Following ingress through portals of entry in the The common association of lactobacilluria and nasopharynx, gastrointestinal, or female genital diabetes mellitus was an interesting finding. The tract Bacteroides infections usually produce sup- details are illustrated in Figure 1. In brief, lacto- purative foci in soft tissues or bones and may or bacilluria in a male of any age except in the newborn may not be associated with septicaemia. In clinically period, or in a woman 50 years old or older was significant infections the concomitant isolation of associated with diabetes mellitus in approximately another organism, usually a micro-aerophilic or 50% of cases. Presumably, increased tissue glucose anaerobic streptococcus, is found in about one- is the altered ecological factor of greatest significance. quarter to one-half of cases. Bacteroides species rarely have been proved CLOSTRIDIUM In spite of numerous published urinary tract pathogens: a single case of pyelo- J Clin Pathol: first published as 10.1136/jcp.19.6.573 on 1 November 1966. Downloaded from Anaerobic bacteria in routine urine culture 575 nephritis with calculus formation in which a in pure culture on six different occasions from six Bacteroides species was isolated from urine in pure different patients. Five of the six isolates were from culture (Beigelman and Rantz, 1949); a report of females. This finding would be in agreement with Bacteroides funduliformis isolated in pure culture Bergey (Breed, Murray, and Smith, 1957) that the from a perinephric abscess (Smith and Ropes, 1945); usual source of these organisms
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