title: 1H-nuclear magnetic resonance spectroscopy for identifying and quantifying common uropathogens: a metabolic approach to the urinary tract infection.
abstract: OBJECTIVE
  To address the shortcomings of urine culture for the diagnosis of urinary tract infection (UTI), we used 1H-nuclear magnetic resonance (NMR) spectroscopy for identifying and quantifying Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia and Proteus mirabilis.
  
  
  METHODS
  Urine samples from patients with suspected UTI (617), healthy volunteers (50) and commercially available standard strains of E. coli, K. pneumonia, P. aeruginosa, Enterobacter, Acinobacter, Pr. mirabilis, Citrobacter frundii, Streptococcus saprophyticus and Enterococcus faecalis were assessed between 2003 and 2006. 1H-NMR spectra were recorded on a 400 MHz spectrophotometer; to quantify the bacteria we estimated the areas under the spectral peaks of the specific metabolic product compared with the known concentration of trimethyl silyl propionic acid. All urine specimens were cultured in addition to an assessment by NMR spectroscopy.
  
  
  RESULTS
  Preliminary urinary spectroscopy of the unprocessed samples showed peaks of nonspecific metabolites such as succinate, acetate, lactate and ethanol, indicating infected samples. Based on the results from processed samples, 93% (240/256) of E. coli, 92% (101/110) of K. pneumoniae, 93% (56/60) of P. aeruginosa and eight of 10 Pr. mirabilis could be diagnosed with NMR (numerator) and urine culture (denominator). The remaining samples were sterile and/or had a bacterial population of <10(3) colony-forming units (CFU)/mL. The NMR method diagnosed bacterial densities of >10(3) CFU.
  
  
  CONCLUSIONS
  The identification of the common uropathogens E. coli, K. pneumoniae, P. aeruginosa and Pr. mirabilis by NMR spectroscopy has a shorter reporting time and can be used to differentiate between infected, contaminated and sterile specimens.
authors.affiliation: Centre of Bio-Medical Magnetic Resonance, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Gupta
authors.forename: Mayank
authors.initials: M
authors.lastname: Dwivedi
authors.forename: Abbas Ali
authors.initials: AA
authors.lastname: Mahdi
authors.forename: G A Nagana
authors.initials: GA
authors.lastname: Gowda
authors.forename: Chunni Lal
authors.initials: CL
authors.lastname: Khetrapal
authors.forename: Mahendra
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000652:urine; D016022:Case-Control Studies; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods* / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000382:microbiology* / Q000652:urine