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May 9, 2012

Purple Urine Bag Syndrome

Author Affiliations

Author Affiliations: Division of Infectious Diseases, VA Medical Center, Minneapolis, Minnesota (johns007@umn.edu).

JAMA. 2012;307(18):1913. doi:10.1001/jama.2012.3584

To the Editor: The rationale for the urine culture that is included as part of the correct response to the patient with PUBS is unclear.1 Because the patient had a chronic indwelling urinary catheter, bacteriuria is predictably present regardless of the urine's appearance or odor, which makes a positive culture highly nonspecific and therefore of little diagnostic value. The utility of defining the identity and susceptibility profile of whatever urine organisms might be present is low unless antimicrobial therapy is to be given. However, antimicrobial therapy should not be given in this case because PUBS (like all asymptomatic bacteriuria except during pregnancy and prior to invasive urological procedures)2 apparently is benign and antimicrobial therapy is not. This patient's physician exhibited commendable restraint in not responding to the patient's positive urine culture with antimicrobial therapy. But why even risk the temptation to treat? Better not to do the culture in the first place.

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