Purple urine bag syndrome - a sign of urinary tract infection, or just of urinary catheter bacterial colonization: A case report

Introduction. Purple urine bag syndrome is a condition where the urinary catheter bag turns purple as a result of the interaction between bacteria, urine and components of the urine bag. It appears in a certain group of patients with the following risk factors: urinary tract infection, older age, long-term indwelling urinary catheter, constipation, chronic kidney disease. Case Report. Two patients with purple urine bag syndrome are presented. The first patient, a 66-year-old man, was hospitalized due to decompensation of alcoholic liver cirrhosis. A urinary catheter was placed on admission, and on the fourteenth day of hospitalization, a purple discoloration of the urine in the urinary bag was noticed. Multidrug-resistant Proteus mirabilis and Enterococcus faecalis were isolated by microbiological analysis of urine. The second patient was a 92-year-old man, hospitalized for acute gastrointestinal bleeding in the form of hematochezia, with an indwelling urinary catheter and a history of a prostate cancer surgery. On the third hospital day, a purple content in the urinary catheter bag was detected and Klebsiella pneumoniae and Morganella morganii were confirmed by bacteriological analysis. Both patients were without clinical and laboratory signs of acute infection. In both cases, the urinary catheter was replaced and ceftriaxone was administered empirically. Conclusion. Current guidelines for purple urine bag syndrome recommend catheter replacement and empiric antibiotic therapy. In clinical practice, it is necessary to emphasize that urine sampling for bacteriological analysis is performed only after replacing the catheter, in order to establish the exact etiology of the syndrome and radical use of antibiotics.