Urinary tract infection localization in women.

The site of urinary infection in 51 adult women was determined by the bladder-washout technique (BW). Of the 37 patients with proved upper-tract infection shown by BW, 16 had upper-tract symptoms, three had lower-tract symptoms, and 18 were asymptomatic; 31 had antibody-coated bacteria (ACB), and six had no ACB. Of 14 patients with proved lower-tract infection shown by BW, three had upper-tract symptoms, five had lower-tract symptoms, and six were asymptomatic; none had ACB. All 31 women whose infecting bacteria were coated with antibody proved to have an upper-tract infection shown by BW. A subset of the population of adult women with upper-tract infection have organisms emanating from their ureters at BW localization, which are not coated with antibody. Physicians must be cautious in interpreting results that are negative for ACB.