Case analysis of purple urine-bag syndrome at a long-term care service in a community hospital.
BACKGROUND
Purple urine-bag syndrome (PUBS) is a rare phenomenon in which the contents of urine bags turn purple or blue following patient catheterization. The condition often causes care givers tremendous distress. We investigated the prevalence and possible causes of PUBS for a group of elderly patients.


METHODS
A total of 157 patients featuring urine catheterization, 13 of whom exhibiting PUBS were analyzed with regards to age, functional status, duration of catheterization, number of daily medications, living location, feeding route, bowel habits, and the pattern of use of a urinary catheter. Urine samples were cultured from all the PUBS patients participating.


RESULTS
Two men who underwent cystostomy and 11 women who underwent urethral catheterization who exhibited PUBS were observed for this study. The age, duration of catheterization, number of daily medications feeding pattern and functional status between the group exhibiting PUBS and the group of patients without PUBS demonstrated no significant differences. A total of 69.2% of the PUBS-affected patients, as compared to 43.1% of the non-PUBS patients, lived in nursing homes, and 84.6% of the PUBS-affected patients were constipated, as were 66% of the non-PUBD subjects. In total, 72.7% of PUBS patients were reported to be using a laxative suppository, compared with 41% of the non-PUBS group, whereas 92.3% of PUBS patients were catheterized using a plastic (PVC) foley, as compared to 70.8% of the non-PUBS patients. The pH for 12 out of 13 PUBS patients' urine was > or = 7. Escherichia coli, Provendicia var. spp., Proteus mirabilis, Klebsiella pneumoniae were the common pathogens isolated from the urine samples provided by our PUBS patients.


CONCLUSIONS
We found that PUBS was more likely associated with the female gender, alkaline urine, constipation, institutionalization, the use of a plastic (PVC) urinary catheter, and certain bacteria such as Provendicia var. spp., Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae.
Su
Fu-Hsiung
FH
Department of Family Medicine, Cardinal Tien Hospital, Hsin Tien, Taipei, Taiwan, ROC.
Chung
Shin-Yi
SY
Chen
Mey-Huy
MH
Sheng
Mei-Ling
ML
Chen
Ching-Hao
CH
Chen
Ya-Jung
YJ
Chang
Wen-Cheng
WC
Wang
Lan-Ying
LY
Sung
Kai-Yang
KY
D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007200:Indican / Q000652:urine*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D013577:Syndrome; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000382:microbiology* / Q000652:urine; D014556:Urine / Q000737:chemistry / Q000382:microbiology
D007200:Indican