| dc.description.abstract | 1. The literature regarding the etiology and pathology
of human urinary tract infections has been reviewed.
Particular reference was paid to factors involved in the
initiation and perpetuation of urinary infection in man
by an ascending route. ||
2. Animal experimental models used to study the human
disease were considered in detail. Some of the limitations in the application of these results were
considered. ||
3. The literature regarding methods used to diagnose
the presence and the severity of human urinary infection
was considered, namely: quantitative and semi- quantitative culture of urine, Gram stain of uncentrifuged urine,
pyuria, white cell excretion rate, estimation of white
cell concentration, "pyrexal" and prednisolone tests,
radiology of the urinary tract including the demonstration of vesico- ureteral reflux, serological typing of
urinary strains of Escherichia coli and the serum antibody response to a urinary infection. ||
4. The concept of "significant bacteriuria ", developed
by counting the numbers of viable organisms present in
1 ml. of voided urine, was considered in detail with
reference to the findings of Kass (1956). The
importance of asymptomatic bacteriuria in pregnancy and
the possible complications associated with the presence
of this condition were considered. ||
5. Chemical and bacteriological screening tests used
to detect women with significant bacteriuria were
considered. ||
6. The modified nitrite test and the triphenyl tetra - zolium chloride (T.T.C.) test to detect significant
bacteriuria were evaluated in 1,000 specimens of urine
from antenatal and infertile women. The former test
detected 69 out of 71 or 97% of urine specimens with
significant bacteriuria as determined by a quantitative
culture technique. The T.T.C. test detected only 54 or
765 of these infected urines. ||
7. A total of 9,741 consecutive pregnant women
attending the Simpson Memorial Maternity Pavilion had
urine specimens examined by the extended nitrite test.
All positive by this test had a confirmatory quantitative
culture of this urine specimen done. Of these, 595 or
6.1% were found to have significant bacteriuria. ||
8. 1,443 married but infertile women attending the
Infertility Clinic also had urine specimens examined.
Of these, 118 or 8.2% were found to have significant
bacteriuria. This finding was compared to the reported
incidence in mature unmarried women and school -children.
It was postulated that marriage and sexual intercourse
was a factor in initiating the occurrence of significant
bacteriuria in pregnant women. Kass's claim (1960) that
all women with bacteriuria of pregnancy acquire it in
250.
the first two months of pregnancy was considered
unlikely. ||
9. A group of 127 women with asymptomatic bacteriuria
were included in a treatment trial. Suiphadimidine or
cycloserine was given for two weeks to alternate women
in the trial and the results evaluated during the
remainder of pregnancy by examination of specimens of
urine by quantitative culture technique. ||
10. The immediate result of treatment in each case was
evaluated by examination of a specimen of urine one week
after cessation of therapy. In 96 out of 127 or 75.6%
the treatment was successful. ||
11. The long -term results were more disappointing since
only 65 or 51.2% of these 127 women remained uninfected
during the rest of pregnancy. In 31 women there was a
recurrence of bacteriuria during the follow -up period. ||
12. There was no significant difference in the results
obtained by these two drugs. ||
13. The occurrence of the following complications
during pregnancy, viz., bacteriologically proven acute
urinary infection with symptoms, anaemia, toxaemia or
hypertension, prematurity by weight, prematurity by
gestation, abortion, and total foetal loss was determined
in treated and untreated women with bacteriuria and a
non-bacteriuric control group of pregnant women. ||
14. There was a highly significant difference in the
incidence of symptomatic infections in the treated and
untreated women with bacteriuria and the non -bacteriuric
control group. Successful treatment of asymptomatic
bacteriuria was highly effective in preventing symptomatic infection during pregnancy. ||
15. The incidence of anaemia was significantly higher
in pregnant women with bacteriuria which was untreated
or unsuccessfully treated when compared with non - bacteriuric or successfully treated women. ||
16. The incidence of toxaemia or hypertension was not
significantly reduced by successful treatment or
asymptomatic bacteriuria of pregnancy. The incidence
of this complication was significantly higher in
bacteriuric women when compared to non -bacteriuric
controls. ||
17. No correlation between the incidence of prematurity
and bacteriuria of pregnancy was found. ||
18. The incidence of abortion and total foetal loss was
significantly higher in the untreated bacteriuric pregnant women in comparison with the other groups. ||
19. A standardised method for estimating the in vitro
sensitivity of urinary pathogens to sulphadimidine has
been developed. ||
20. There was good correlation between the results of
in vitro sensitivity tests and the clinical response to
treatment in 52 out of 62 patients in the trial. ||
21. There was no significant relationship between the
results of in vitro sensitivity tests and the clinical
response to treatment in 65 women treated with cycloserine. These findings are discussed. ||
22. Rabbit antisera to the following standard
Escherichia coli '0' types were prepared, i.e. 01, 02,
04, 06, 07, 087 018, 025, 075, 077. ||
23. It was possible to serologically type 139 or 55.4%
of 251 urinary strains of Escherichia coli with the
above antisera. These typed strains were obtained
during the study of 51 patients with asymptomatic
bacteriuria of pregnancy. ||
24. The relative frequency of occurrence of each of
these '0' types in 47 women with asymptomatic bacteriuria
were determined. '0' type 6 occurred most frequently,
in 11 of these women, '0' type 75 in nine women and '0'
type 2 in eight women. These results are discussed with
reference to results obtained by other workers in this
field. ||
25. The haemagglutination technique of Neter et al.
(1952) for the detection of antibodies to Escherichia
coli has been modified in this study. ||
26. The bacterial agglutination technique and haemagglutination technique for the estimation of antibodies to
urinary strains of Escherichia coli have been evaluated. ||
27. The haemagglutination technique was found to be
more sensitive in estimating the antibody response in 81
non -bacteriuric pregnant women. Ten standard '0' type
strains of Escherichia coli were used as antigens in
each of these patients. ||
28. The antibody response also estimated in 54 women
who were successfully treated for asymptomatic
bacteriuria of pregnancy, 21 women who had a recurrence
of bacteriuria following treatment and in nine
bacteriuric women who failed to respond to treatment. ||
29. In five women who failed to respond to treatment
there was a significant antibody response in three of
whom the rise in antibody titre coincided with the
clinical onset of symptoms of acute pyelonephritis. | en |
