difficulty in detecting enterococcus

[copyeditor]

found this on the internet the other day and thought it was interesting:

"In today's office practice, the dipstick test for nitrite is used as a surrogate marker for bacteriuria. It should be noted that not all uropathogens reduce nitrates to nitrite. For example, enterococci, S. saprophyticus and Acinetobacter species do not and therefore give false-negative results."

i'm just adding that to my research. thought some of you might appreciate it.

[mich2604]

Thanks for posting this info. this is so interesting to me.

When this bladder nightmare began, I ended up in the ER, they did a test and it showed high nitrates.......yet NO bacteria was grown at all. I found out a week later i had BV.

Now when i get a UA done it shows high White blood cells 7-8+, no nitrates and no bacteria.

I sent a sample to UML and they found the Strep D. Ive tried treating it, but it seems I just cant tolerate the amoxy.


I also have Lyme disease.

[meg31]

Thanks for posting this info! My uro has actually found enterococcus in my urine once but hasn't found it again and wont give me antibiotics. I know standard lab tests are worthless for IC so I went to UML to get the broth done but it came back negative. I was on a low dose of Augmentin at the time though and I suspect that when I go back after being off antibiotics that it will show up again. That bugger is hard to detect. I just wish more doctors knew about this!

Thanks,
Meg

[hollipop]

That is so awesome! I have/had enterococci, so this makes total sense to me. I also had a broth culture at UML to find it and have been on amoxicillin for 4 months. I feel great now.

[webslave]

That is so awesome! I have/had enterococci, so this makes total sense to me. I also had a broth culture at UML to find it and have been on amoxicillin for 4 months. I feel great now.

Good for you, Hollipop. Just be aware that Amoxycillin (Imacillin) has been shown to decrease bowel inflammation in ulcerative colitis (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9552221&dopt=Abstract) as well, so it has powerful anti-inflammatory effects that could be helping you.

[PlainJane]

Everyone mentions the anti-inflammatory effects of antibiotics but I have to say I've never experienced this. I would love some placebo effect right now :) But in your case Hollipop I doubt it is just the anti-inflammatory effects or placebo effects. It's probably that the enterococcus was causing you problems. Anyway I hope the antibiotics help you. Thank goodness for broth cultures, eh?

~plainjane

[hollipop]

Everyone mentions the anti-inflammatory effects of antibiotics but I have to say I've never experienced this. I would love some placebo effect right now :) But in your case Hollipop I doubt it is just the anti-inflammatory effects or placebo effects. It's probably that the enterococcus was causing you problems. Anyway I hope the antibiotics help you. Thank goodness for broth cultures, eh?

~plainjane

Thanks, plainjane. I've been symptom free for nearly half a year now and praise the fact that I found out about the broth culture before I had my bladder removed. :bow:

[webslave]

Everyone mentions the anti-inflammatory effects of antibiotics but I have to say I've never experienced this. I would love some placebo effect right now :) But in your case Hollipop I doubt it is just the anti-inflammatory effects or placebo effects. It's probably that the enterococcus was causing you problems. Anyway I hope the antibiotics help you. Thank goodness for broth cultures, eh?

~plainjane

My post has nothing to do with placebo effect. The anti inflammatory aspect of antibiotics are well known, and Dr Anthony Schaeffer himself has said that that is what is most probably responsible for the temporary help they give men with "male IC" aka CPPS.

"Broth cultures" are an interesting topic. Most uros think they are a waste of time (http://www.chronicprostatitis.com/epscultures.html).

[hollipop]

webslave - I don't have a prostate, so that link does not have any bearing on my case.

[webslave]

webslave - I don't have a prostate, so that link does not have any bearing on my case.

That's ok. The comments on the value of broth cultures were what I wanted you to read. Remember that "prostatitis" and "interstitial cystitis" are often one and the same thing, as people like Dr Pontari will tell you.

[PlainJane]

Hollipop,

Thats good news that you are feeling better! I wasn't trying to be antagonistic with my comment about the placebo effect sorry if it came across that way.

Copyeditor,
How are you feeling these days? Have you found anything that helps yet? I hope so!

~plainjane

[ICNDonna]

There's a huge difference between "placebo effect" and "anti-inflammatory qualities." A placebo has no medicine and is what is used when doing clinical trials for new medications --- some people will respond to the placebo --- instead of calling it psychological, it's sometimes called placebo effect.

Anti-inflammatories can actually decrease the swelling and pain with a condition. When antibiotics were first discovered and used, it was like something magical --- children with severe infections were healed almost overnight. Not surprisingly, antibiotics were given freely for many years. Then it was discovered that those nasty germs developed antibiotic-resistance so it takes much longer for them to work now. Most doctors will order cultures done when infection is present; some will order wide spectrum antibiotics while waiting for culture results.

I personally would only want a broth culture done if it could be done in my own city so I could have the sample taken by catheter to prevent contamination and have the culture begun immediately for the same reason.

Donna

[MarthaF]

Yes, if there is infection and inflammation antibiotics will treat the infection and the inflammation will subside. What causes the inflammation in the first place ? Very probably a bacterial infection.

If a specimen is collected with care after cleansing the area and caught in midstream, there should not be contamination. United Medical Lab reports that the specimens they receive are usually very clean.

Sending a specimen across country, or the ocean, does not change the original contents that were in the specimen in the first place. There is no such thing as spontaneous generation of bacteria. The lab reports any growth and the colony count is not the key. If there are symptoms and bacteria, in combination, then an active infection should be considered. If there are bacteria but no symptoms then the bacteria are not causing a problem.

A large percentage of the population has H.plyori in their stomachs. Only a small percentage of the population actually develops an ulcer, so bacteria can and do reside in our bodies without a problem. E. coli and Enterococci are abundant inhabitants of our intestines and we need them. They are also in our bladders often and usually do not cause a problem or a washed out. But in some there are triggers that activate a symptomatic infection, problably different ones for different people. Research is ongoing as to why some are affected.

Martha

[webslave]

Sending a specimen across country, or the ocean, does not change the original contents that were in the specimen in the first place. There is no such thing as spontaneous generation of bacteria. The lab reports any growth and the colony count is not the key. If there are symptoms and bacteria, in combination, then an active infection should be considered. If there are bacteria but no symptoms then the bacteria are not causing a problem.

That's not quite true. Urine is graded as to bacterial count, and a decision is made according to the count of bacteria present as to whether there is infection or not. Now bacteria multiply, given time. Ever let your urine stand in a toilet bowl for a few days?

You may find this message from Usenet (http://groups.google.com/group/sci.med.prostate.prostatitis/msg/369d19ade10bdb03?dmode=source&hl=en&output=gplain) interesting in this regard.

[MarthaF]

The typical UTI caused by E.coli i(a Gram negative species) is the only instance when a "colony count" is used. We believe the real pathogen in many chronic urinary tract symptomatic patients is a Gram positive such as Enterococcus or Staphlylococcus. These are not found by the typical agar plate technique used by clinical labs since they are slow growing and do not grow in large numbers.

When someone has a strep throat they do not "count colonies". If there are symptoms and Streptococci are found the patient is diagnosed with strep throat. The same is true in other infectious diseases. Enterococcus is a form of strep and it does not matter how many colonies are found - if there are symptoms and the bacteria are there in any number an infection should be suspected.

Martha

[webslave]

When someone has a strep throat they do not "count colonies".

They don't have to. The throat, unlike the bladder and urethra, is not a conduit for bodily fluids.

If there are symptoms and Streptococci are found the patient is diagnosed with strep throat. The same is true in other infectious diseases. Enterococcus is a form of strep and it does not matter how many colonies are found - if there are symptoms and the bacteria are there in any number an infection should be suspected.

Again, that's not true. Let me quote Dr Fishbane of Stony Brook University Hospital:

Normal urine is sterile. UTI can therefore be diagnosed if a single viable gram negative bacterium inhabits the urinary tract (kidney, ureters, bladder). In reality, the bacteria causing UTI multiply in log phase growth in normal urine, and most people with urinary tract infection have 104-106 bacteria/ml. The acute number will depend on the urine flow rate, characteristics of the urine, the duration of infection, etc. The problem in diagnosis is that of contamination arising from voided specimens passing through the non-sterile distal urethra. For this reason, clinicians use the criteria of 105 bacteria/ml of “clean catch” urine to diagnose UTI. At this level, < 1% of the represent contaminants. At counts of 1000-10,000/ml, there is a 50/50 chance the result represents contamination. Such a count may represent true infection, but to be sure a second culture showing the same organism might be more convincing.

Anyone telling you that any number of bacteria in urine indicates infection is simply lying, or conning you. Follow the money, I always say.

[PlainJane]

In my opinion and experience the standard UTI cultures miss a number of chronic infections. Martha is absolutely right that the standard urine cultures really only detect e.coli and not pathogens like enterococcus.

We could probably debate "counting colonies" endlessly but it seems to me at least that the most proof is in the patients. Do they recover or do they not when treated with appropriate antibiotics for infections detected by broth culture? I think a great majority do as far as I can tell. People like Hollipop and others have their lives back. That is personally all the proof I need.

And another thing. This is something I will never understand but of course I'm not a doctor. If your patients' culture results come back positive for enterococcus (or any bug for that matter) AND she has symptoms why would you NOT treat the infection with the appropriate antibiotic for an appropriate length of time? It seems only logical that you would want to rule out the infection before diagnosis a disease like IC. But again I am not a doctor this is just my personal opinion.

~plainjane

[webslave]

We could probably debate "counting colonies" endlessly but it seems to me at least that the most proof is in the patients. Do they recover or do they not when treated with appropriate antibiotics for infections detected by broth culture? I think a great majority do as far as I can tell.

Let's just say that published, peer-reviewed, double blinded, placebo controlled studies are utterly lacking, eh? :bonk:

People like Hollipop and others have their lives back. That is personally all the proof I need.

People involved in medicine and science need a little more than anecdotal evidence, sadly.

And another thing. This is something I will never understand but of course I'm not a doctor. If your patients' culture results come back positive for enterococcus (or any bug for that matter) AND she has symptoms why would you NOT treat the infection with the appropriate antibiotic for an appropriate length of time? It seems only logical that you would want to rule out the infection before diagnosis a disease like IC. But again I am not a doctor this is just my personal opinion.

Well, the uro will look at whether the pathologist reports the bug as a contaminant or as an infection, a decision made, as I previously explained, by the numbers. If treating women (or men) with LUTS (lower urinary tract symptoms) with long courses of antibiotics actually helped, they'd do it. Unfortunately, good scientific studies have shown that, at least in men with LUTS, antibiotics provide only temporary relief, no more than placebo eventually. I quote:

Conclusions: This small pilot controlled study showed that six weeks of levofloxacin therapy resulted in early and significant improvement in symptoms in men diagnosed with CPPS. Improvement continued during and after treatment but was not significantly different from placebo. The clinical ramifications of these findings needs to be addressed.

[PlainJane]

Meh whatever I don't want to argue about this. Besides I am not the person who should be responding anyway Martha is since she knows about this stuff.


Well either way if you decide to go ahead with broth culture or whatever good luck with your health struggles and your medical research.

~plainjane

[webslave]

Someone may already have posted this here ...:
Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain. (http://www.chronicprostatitis.com/forum/viewtopic.php?t=4298)