Reverse-flow apparatus for enhanced colorimetric detection of bacteriuria.

The reverse-flow apparatus is a new device for enhancing the detection of bacteria in urine. Bacteria are trapped onto a customized filter, and the pigments, crystals, and other interfering substances in the urine pass through the filter and are discarded. The bacteria are backflushed and are recovered as a concentrate, and the concentrate is then processed through the previously described colorimetric bacteriuria detection device. A total of 1,000 urine samples were obtained from randomly selected patients and were cultured on agar. Upon enumeration of the colonies, 160 urine samples were shown to contain more than 10(5) CFU/ml. In the bacteriuria detection device, 150 urine samples could not be processed (pigmenters and cloggers), and of the 850 urine samples processed, 127 were culture positive for 10(5) CFU/ml or greater, and 150 urine samples contained between 10(4) and 10(5) CFU/ml. At 10(5) CFU/ml, there were 140 false-positives and 14 false-negatives. When duplicate urine samples were processed through and concentrated by our new reverse-flow apparatus, all samples, including the above pigmenters and cloggers, could be tested in the bacteriuria detection device. The 150 unprocessable samples described above yielded 33 additional bacteria-positive urines, 23 at the 10(5)-CFU/ml cutoff and 10 at the 10(4)-to-10(5)-CFU/ml cutoff. There were 105 false-positives at 10(5) CFU/ml and only 2 false-negatives at the same level of bacteria. At 10(4) to 10(5) CFU/ml there was only 1% false-positive and 4% false-negative. The reverse-flow apparatus allows greater specificity and sensitivity in the rapid bacteriuria test. Urine containing 10(4) CFU/ml or more can now be detected with a 96% sensitivity in a total processing time of less than 2 min.