To the Editor.
—The article by Dr Avorn and colleagues1 is flawed. The conclusions of this article are flawed because all urine samples were taken from "elderly women," and they were all voided specimens. What the authors may have been measuring is the bacteria present in the vaginal flora. As a urologist in practice for several decades, I have seen hundreds of elderly women in whom the treating physician was unable to "cure her infection." Invariably, they were assessing voided specimens of urine. When a specimen was obtained by catheter, the infection magically disappeared.It is virtually impossible to obtain a proper "clean-voided specimen" from an elderly female, especially if she is somewhat obese. There is an extremely high incidence of vaginal contamination. I have learned to start with a voided urine sample; if it shows bacteriuria, I will then get a catheterized urine sample. The evidence for bacteriuria
Goodfriend R. Reduction of Bacteriuria and Pyuria Using Cranberry Juice. JAMA. 1994;272(8):588. doi:10.1001/jama.1994.03520080030022