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Objective. To assess the cost effectiveness of four strategies in the prevention of neonatal infection with group-B streptococci (GBS). Design. Cost-effectiveness analysis. Method. A modelling study was carried out in which the effects and the fondercosts of intrapartum antibiotic prophylaxis (IAP) in accordance with the guideline from the Dutch Association of Obstetrics and Gynaecology and the Dutch Association of Paediatrics (IAP in case of the risk factors fever, bacteriuria caused by GBS or a previous GBS-infected child and IAP in case of the risk factors premature birth and protracted ruptured membranes, on the basis of culture results or the clinical judgement of the physician) were compared to the effects and the costs of a risk strategy (directly IAP in case of any of the 5 mentioned risk factors), a screening strategy (screening and subsequent IAP in women with GBS or an unknown GBS status) and a combination strategy (screening and subsequent IAP in women with GBS and a risk factor, and in women with unknown GBS status and a risk factor) in a hypothetical cohort of 200,000 bearing women. Results. The risk strategy would prevent 352 cases of perinatal GBS infection at a cost of approximately EUR 5 m indicating a cost-effectiveness ratio of EUR 7,600 per quality-adjusted life year (QALY) gained. The combination strategy would have comparable results. These strategies dominated the guideline, which was less effective at a higher cost. The screening strategy was shown to be the most effective by preventing 470 perinatal GBS infections, but due to considerable costs led to an unfavourable cost-effectiveness ratio. Introducing the real time-polymerase chain reaction (PCR) test into the combination strategy during labour would lead to the most favourable cost-effectiveness ratio. Conclusion. In the Dutch system the risk strategy and the combination strategy seemed to be reasonably cost-effective. However to assess their real cost effectiveness, the performance of both strategies should be determined in clinical practice. The feasibility of alternative strategies should be further explored in choosing the strategy most applicable to Dutch clinical practice.

Objective. To assess the cost effectiveness of four strategies in the prevention of neonatal infection with group-B streptococci (GBS). Design. Cost-effectiveness analysis. Method. A modelling study was carried out in which the effects and the fondercosts of intrapartum antibiotic prophylaxis (IAP) in accordance with the guideline from the Dutch Association of Obstetrics and Gynaecology and the Dutch Association of Paediatrics (IAP in case of the risk factors fever, bacteriuria caused by GBS or a previous GBS-infected child and IAP in case of the risk factors premature birth and protracted ruptured membranes, on the basis of culture results or the clinical judgement of the physician) were compared to the effects and the costs of a risk strategy (directly IAP in case of any of the 5 mentioned risk factors), a screening strategy (screening and subsequent IAP in women with GBS or an unknown GBS status) and a combination strategy (screening and subsequent IAP in women with GBS and a risk factor, and in women with unknown GBS status and a risk factor) in a hypothetical cohort of 200,000 bearing women. Results. The risk strategy would prevent 352 cases of perinatal GBS infection at a cost of approximately EUR 5 m indicating a cost-effectiveness ratio of EUR 7,600 per quality-adjusted life year (QALY) gained. The combination strategy would have comparable results. These strategies dominated the guideline, which was less effective at a higher cost. The screening strategy was shown to be the most effective by preventing 470 perinatal GBS infections, but due to considerable costs led to an unfavourable cost-effectiveness ratio. Introducing the real time-polymerase chain reaction (PCR) test into the combination strategy during labour would lead to the most favourable cost-effectiveness ratio. Conclusion. In the Dutch system the risk strategy and the combination strategy seemed to be reasonably cost-effective. However to assess their real cost effectiveness, the performance of both strategies should be determined in clinical practice. The feasibility of alternative strategies should be further explored in choosing the strategy most applicable to Dutch clinical practice.

Asymptomatic bacteriuria is a common medical condition, especially in women and elderly people. It is generally considered to be a benign condition, which does not require screening or antibiotic treatment. However, there are a few exceptions for which screening is possibly worthwhile. For children it is unclear whether the early detection of ASB can result in better clinical outcomes. Screening is therefore not advised, except for young children during the first few months after a symptomatic urinary tract infection. For pregnant women the use of screening for ASB is also unclear and in general not indicated. Research is necessary into the possible transition from ASB to pyelonephritis and the possible connection with low birth weight and premature births. There are indications that ASB in women with type I diabetes mellitus can lead to a deterioration in the renal function, yet these are insufficient to recommend screening as a routine procedure.

Urinary tract infections (UTIs) are an important medical problem for women. The most common uropathogen is Escherichia coli. The adherence of E. coli to the uroepithelium is mediated by the FimH adhesin, a minor component of type-1 fimbriae. This is the initial step in the pathogenesis of UTIs. Recently, a candidate vaccine has been developed, based on this FimH adhesin. In animal studies and in a phase 1 study, this vaccine has proven to be both immunogenic and safe. In this era of increasing resistance to antibiotics, such a method of prevention is of high importance.

Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) more frequently than women without DM. For type 1 diabetes mellitus, risk factors for asymptomatic bacteriuria include a longer duration of diabetes, peripheral neuropathy and macroalbuminuria. For type 2 diabetes, the risk factors are higher age, macroalbuminuria and a recent symptomatic UTI. Poorly-controlled diabetes and residual urine after urination are no risk factors. The most important risk factor for a UTI in type 1 diabetes patients is sexual intercourse. In type 2 diabetes patients the major risk factor is the presence of asymptomatic bacteriuria. This higher prevalence does not appear to be based on a difference in virulence of the causative microorganism. Differences in host response may explain this higher prevalence: E. coli with type 1 fimbriae adhere better to uroepithelial cells in women with DM than to those in women without DM; women with DM and ASB have lower urinary cytokine concentrations and leukocyte counts compared to women without DM and ASB; in vitro studies show that E. coli grow better when glucose is present in urine. There is no consensus on whether ASB should be treated in these patients. There are indications that UTIs in diabetes patients should be treated as complicated UTIs.

Asymptomatic bacteriuria in healthy non-pregnant women is common, mostly transient and benign, whilst antimicrobial drug treatment is highly successful in women with a symptomatic and uncomplicated urinary tract infection. So, from a practical point of view the need to treat could be solely based on patients' preferences and symptoms. Yet recent Dutch professional guidelines have chosen an objective diagnosis based on the examination of a urine sample, although consensus is still lacking as to the most effective and efficient diagnostic method. In the debate about predictive values and the practical consequences of the various methods, the differences in the pathological backgrounds of the tests can easily be overlooked. Bacteriuria and inflammatory response have a causal connection, but reflect distinct phenomena. Symptoms do not necessarily result from the former but may result from the latter. Attention needs to be paid to these triangular correlations in future studies.

In this investigation the results obtained with a testkit for detecting bacteria and their antibiotic sensitivity (ABcheck, Vétoquinol) were compared with those obtained using standard bacteriological procedures. Ten urine samples, ten skin samples, and ten cerumen samples were examined in parallel. The results indicate that the testkit is not reliable with respect to whether antibiotics should be administered and with respect to which antibiotics should be used.

The urinary tract is the principal site of infection in diabetics. A changed bacterial adhesion to the uroepithelium, partly as a result of a changed and lowered Tamm Horsfall Protein, and granulocyte dysfunction, possibly as a result of an abnormal intracellular calcium metabolism, are involved in the pathogenesis of urinary tract infections in diabetics. The main risk factors for bacteriuria in female diabetics are more advanced age and more frequent sexual intercourse. Diabetic patients run an increased risk of complications of urinary tract infection. If a symptomatic infection exists, the treatment of choice is antibiotics which can reach high tissue levels. It is not clear if asymptomatic bacteriuria needs medical treatment.

The validity of clean-voided urine culture results was investigated in 100 consecutive admissions to the geriatric ward of a general hospital. Culture of clean-voided urine was compared with urethral catheter specimens as reference. Clean-voided and catheter specimens were obtained in 71 cases. The investigation included 67 cases. One clean-voided specimen was false positive. Two cultures were false negative. Three of the four patients with a urinary tract infection did not present with the typical symptoms, but with a general decline in physical and/or mental function. In this population a clean-voided urine culture is reliable enough to confirm the diagnosis of urinary tract infection.

As part of a research project concerned with the monitoring of health problems in sows, the practicability of post-mortem urinalysis of sows during slaughter was studied to determine the extent to which this analysis was useful. Samples of urine were taken from 232 sows after slaughter to test them for pH, nitrite and blood concentrations by test strips (Combur-8, Boehringer Mannheim). Positive results of testing were found not to be associated with pathological disorders of the genito-urinary system to any marked extent. Samples of urine taken pre- as well as post-mortem from 111 other sows were subjected to same tests. During the process of slaughter, the pH was found to show a decrease, whereas the concentrations of protein and blood increased. The results of post-mortem tests for nitrite were definitely not correlated with those of pre-mortem tests. The results of testing urine sampled prior to slaughter at the farm were related to post-mortem pathological findings to a greater extent than were the results of testing after slaughter.