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Bacteriuria: Colonization or Infection-Reply

Walter E. Stamm, MD; Richard Daifuku, MD
JAMA. 1985;253(13):1879. doi:10.1001/jama.1985.03350370058018.
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In Reply.—  Dr Kozinn and colleagues call attention to the semantic confusion that exists regarding the terms used to define UTI in asymptomatic catheterized patients. Ideally, one would like to distinguish between colonization, asymptomatic infection, and symptomatic infection.1 Colonization is usually defined as the multiplication of organisms in or on a host without apparent evidence of invasiveness or tissue injury, while clinical, histologic, or immunologic evidence of host injury or invasion accompanies infection.1 The distinction between colonization and infection in the urinary tract thus rests on (1) the presence of symptoms or signs indicating tissue invasion, (2) the presence of pyuria and/or hematuria, (3) a serological response, or (4) cystoscopic or histologic evidence of mucosal injury. It is not clear that any quantitative level of bacteriuria in catheterized patients correlates with infection rather than colonization. Indeed, patients with lower bacterial counts generally progress to higher counts (≥105

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