Purple urine bag syndrome in nursing homes: Ten elderly case reports and a literature review

Case report

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Authors: Chi-Hung Lin, Hsien-Te Huang, Chia-Chang Chien, Dong-Sheng Tzeng, For-Wey Lung

Published Date August 2008 Volume 2008:3(4) Pages 729 - 734

DOI: http://dx.doi.org/10.2147/CIA.S3534

Chi-Hung Lin¹, Hsien-Te Huang¹, Chia-Chang Chien¹, Dong-Sheng Tzeng^1,2, For-Wey Lung^1,3–5

¹Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; ²Graduate Institute of Occupational Safety and Health; ³Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; ⁴Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; ⁵Calo Psychiatric Center, Pingtung County, Taiwan

Abstract: Purple urine bag syndrome (PUBS) is a rare occurrence, in which the patient has a purple-colored urine bag following urinary catheterization for hours to days. Most of authors believe it is a mixture of indigo (blue) and indirubin (red) that becomes purple. Previous study showed that PUBS occurred predominantly in chronically catheterized, constipated women. We collected 10 elderly patients with PUBS in two nursing homes. The first two cases were identified by chart review in 1987 and 2003, and then later eight cases (42.1%) were collected among 19 urinary catheterized elderly in the period between January 2007 and June 2007. In the present report, PUBS probably can occur in any patients with the right elements, namely urinary tract infection (UTI) with bacteria possessing these enzymes, diet with enough tryptophan, and being catheterized. Associations with bed-bound state, Alzheimer’s, or dementia from other causes are reflections of the state of such patients who are at higher risk for UTI, and hence PUBS occurred. Although we presented PUBS as a harmless problem, prevention and control of the nosocomial catheter-associated UTIs (CAUTIs) has become very important in the new patient-centered medical era. Thus, we should decrease the duration of catheterization, improve catheter care, and deploy technological advances designed for prevention, especially in the elderly cared for in nursing homes.

Keyword: purple urine bag syndrome, indigo, indirubin, nursing home, bacteriuria, indoxyl sulphatase/phosphatase, nosocomial catheter-associated UTIs

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