Limitations of the antibody-coated bacteria test in patients with neurogenic bladders

A Fairley washout test and antibody-coated bacteria (ACB) test were performed for 35 urinary tract infections in 32 patients with neurogenic bladder dysfunction. The Fairley test result was used as a standard reference and was combined with clinical and ureteral catheterization culture findings when doubt existed. The Fairley test localized 35 infections: 9 to the kidney, 24 to the bladder, and 2 to the prostate. The ACB test results were positive in five of the nine renal infections and negative in four. In three of the four patients with negative results, radiological, clinical, or ureteral culture evidence of upper urinary tract infection supported localization to the upper urinary tract. Of the 26 infections localized by the Fairley test to the lower urinary tract, 20 showed negative and six showed positive ACB test results. Two of the six patients with positive results had prostate infections; the other four had chronic or recurrent cystitis. The ACB test cannot be relied on alone to localize urinary tract infections in patients with neurogenic bladder dysfunction.