An update on purple urine bag syndrome

Abstract

Yoshiro Hadano,1 Taro Shimizu,2 Shimon Takada,3 Toshiya Inoue,4 Sumire Sorano51Department of General Internal Medicine and Infectious Diseases, Rakuwakai Otowa Hospital, Yamashina-ku, Kyoto, Japan; 2Rollins School of Public Health, Emory University, Atlanta, GA, USA; 3Department of General Internal Medicine, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan; 4Department of Emergency Medicine, Urasoe General Hospital, Urasoe-city, Okinawa, Japan; 5Kobe University School of Medicine, Kusunokicho, Chuoku, Kobe, JapanAbstract: Purple urine bag syndrome is characterized by the urinary drainage bag turning purple in patients on prolonged urinary catheterization, especially those in the bedridden state. It is associated with bacterial urinary tract infections caused by indigo-producing and indirubin-producing bacteria, usually affects women, and is associated with alkaline urine, constipation, and a high bacterial load in the urine. Almost all patients with purple urine bag syndrome are catheterized due to significant disability, and the urinary pH is 7.0 or more. In general, intensive treatment with antibiotics is not recommended. Purple urine bag syndrome per se almost always appears to be asymptomatic and harmless. However, caution is needed, because some cases have been reported to show progression to severe disease states, so further research into the morbidity and mortality of this infection is warranted.Keywords: purple urine, urinary catheterization, geriatrics, urinary tract infection