Purple urine bag syndrome: experience in 23 patients
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v79i5.409Keywords:
infection, urology, microbiology, purple bag syndromeAbstract
Objective: Purple urine bag syndrome is a rare condition. Neither the underlying disease nor the microbiology of those patients has been adequately reported or studied due to the small number of patients and the types of studies published. The aim of the present work was to describe the clinical characteristics of patients with purple urine bag syndrome seen over a one-year period.
Material and methods: A descriptive study was conducted, within the time frame of March 1, 2016 to February 28, 2017. The clinical characteristics and urine culture results of patients that came to the outpatient consultation of the urology service presenting with purple urine bag syndrome, were analyzed.
Results: Twenty-three patients were studied. Nineteen percent of the patients were men and the mean patient age was 71.3 years. Five (21.7%) of the patients presented with diabetes mellitus and 4 (17.3%) with high blood pressure. Only 3 (13%) patients presented with a symptom associated with urinary infection. The most prevalent pathogen in the urine cultures was Klebsiella pneumoniae in 7 (30.4%) of the patients, followed by Escherichia coli. Two patients presented with recurrence, but they had no symptoms or comorbidities.
Limitations: Study limitations were its retrospective design and the descriptive statistical analysis.
Conclusion: Based on the study population and findings, we believe purple urine bag syndrome is a clinical finding that presents in patients of both sexes that are chronic users of urinary catheters, and is most likely benign, given that a low percentage of patients present with symptoms. However, as stated in the literature, it is recommendable to change the catheter and bag, as well as to perform urine cultures and administer empiric antibiotic therapy in the patients that present with symptoms, to prevent later complications.
References
Llenas-García J, García-López M, Pérez-Bernabeu A, Cepeda JM, Wikman-Jorgensen P. Purple urine bag syndrome: A systematic review with meta-analysis. European Geriatric Medicine. 2017;8(3):221–7. [accessed 23 Oct 2019] Available from: http://www.sciencedirect.com/science/article/pii/S1878764917300499
Barlow GB, Dickson J a. S. Purple urine bags. The Lancet. 1978;311(8057):220–1. [accessed 23 Oct 2019] Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(78)90667-0/abstract
Harun NS, Nainar SKMSH, Chong VH. Purple urine bag syndrome: a rare and interesting phenomenon. South Med J. 2007;100(10):1048–50. doi: https://doi.org/10.1097/SMJ.0b013e318151fba4
Yang H-W, Su Y-J. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomedical Reports. 2018;8(3):249–56. [accessed 23 Oct 2019] Available from: http://www.spandidos-publications.com/10.3892/br.2018.1046/abstract
Lin C-H, Huang H-T, Chien C-C, Tzeng D-S, Lung F-W. Purple urine bag syndrome in nursing homes: Ten elderly case reports and a literature review. Clin Interv Aging. 2008;3(4):729–34. [accessed 23 Oct 2019] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682405/
Vallejo-Manzur F, Mireles-Cabodevila E, Varon J. Purple urine bag syndrome. Am J Emerg Med. 2005;23(4):521–4. doi: https://doi.org/10.1016/j.ajem.2004.10.006
Su F-H, Chung S-Y, Chen M-H, Sheng M-L, Chen C-H, Chen Y-J, et al. Case analysis of purple urine-bag syndrome at a long-term care service in a community hospital. Chang Gung Med J. 2005;28(9):636–42.
Shiao C-C, Weng C-Y, Chuang J-C, Huang M-S, Chen Z-Y. Purple urine bag syndrome: a community-based study and literature review. Nephrology (Carlton). 2008;13(7):554–9. doi: https://doi.org/10.1111/j.1440-1797.2008.00978.x
Hadano Y, Shimizu T, Takada S, Inoue T, Sorano S. An update on purple urine bag syndrome. Int J Gen Med. 2012;5:707–10. [accessed 23 Oct 2019] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437914/
Khan F, Chaudhry MA, Qureshi N, Cowley B. Purple urine bag syndrome: an alarming hue? A brief review of the literature. Int J Nephrol. 2011;2011:419213. doi: https://doi.org/10.4061/2011/419213
Dealler SF, Hawkey PM, Millar MR. Enzymatic degradation of urinary indoxyl sulfate by Providencia stuartii and Klebsiella pneumoniae causes the purple urine bag syndrome. J Clin Microbiol. 1988;26(10):2152–6.
Rooney H, Mokool L, Ramsay A, Nalagatla S. Purple urine bag syndrome: a truly harmless sign? Scott Med J. 2018;63(3):99–101. doi: https://doi.org/10.1177/0036933017743128