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The New England Journal of Medicine Mar 2015
Review
Topics: Bacterial Infections; Colony Count, Microbial; Diagnosis, Differential; Female; Humans; Infections; Male; Mycoses; Pyuria; Sexually Transmitted Diseases; Urine; Virus Diseases
PubMed: 25760357
DOI: 10.1056/NEJMra1410052 -
The New England Journal of Medicine Jun 2015
Topics: Female; Humans; Infections; Male; Pyuria; Sexually Transmitted Diseases; Urine
PubMed: 26061857
DOI: 10.1056/NEJMc1504516 -
The New England Journal of Medicine Jun 2015
Topics: Female; Humans; Infections; Male; Pyuria; Sexually Transmitted Diseases; Urine
PubMed: 26061856
DOI: 10.1056/NEJMc1504516 -
The New England Journal of Medicine Jun 2015
Topics: Female; Humans; Infections; Male; Pyuria; Sexually Transmitted Diseases; Urine
PubMed: 26061855
DOI: 10.1056/NEJMc1504516 -
The American Journal of Medicine Sep 2022Pyuria is often used as an import marker in the diagnosis of urinary tract infection. The interpretation of pyuria may be especially important in patients with...
BACKGROUND
Pyuria is often used as an import marker in the diagnosis of urinary tract infection. The interpretation of pyuria may be especially important in patients with nonspecific complaints. There is a paucity of data to demonstrate the utility of pyuria alone in the diagnosis of bacteriuria or urinary tract infection. This study aims to further define the relationship of pyuria and positive bacterial growth in urine culture, as well as the diagnostic utility of different urine white blood cell cutoff points.
METHOD
A total of 46,127 patients older than the age of 18 were selected from the inpatient population of HCA Healthcare System Capital Division. Urine microscopy results were stratified by white blood cell count and correlated with positivity of urine culture bacterial growth. The optimal urine white blood cell cutoff was derived based on the receiver operating characteristic curve plot.
RESULTS
Urine microscopy finding of white blood cell 0-5 cell/hpf, 5-10 cell/hpf, 10-25 cell/hpf, and higher than 25 cell/hpf was associated with 25.4%, 28.2%, 33%, and 53.8% rates of bacteriuria, respectively. The receiver operating characteristic curve plot demonstrated that pyuria alone did not provide adequate diagnostic accuracy to predict bacteriuria. The optimal cutoff point for the best combination of sensitivity and specificity was found to be 25 cell/hpf.
CONCLUSION
Pyuria alone provides inadequate diagnostic accuracy for predicting bacteriuria. Urine white blood cell count greater than 25 cell/hpf was found to be the optimal cutoff to detect bacteriuria. The result of this study supports the current guideline recommendation against antibiotic treatment based on urine analysis alone. It also informs future design of randomized controlled trial that investigates interventional strategies for patients with pyuria and nonspecific complaints.
Topics: Bacteriuria; Humans; Microscopy; Pyuria; Urinalysis; Urinary Tract Infections
PubMed: 35580716
DOI: 10.1016/j.amjmed.2022.04.022 -
Mayo Clinic Proceedings Nov 2021
Topics: Aged; Biopsy; Carcinoma, Papillary; Cystoscopy; Diagnosis, Differential; Dissection; Humans; Male; Neoplasm Grading; Neoplasm Staging; Prognosis; Pyuria; Urinary Bladder Neoplasms; Urothelium
PubMed: 34736606
DOI: 10.1016/j.mayocp.2021.08.022 -
Therapeutic Advances in Urology Oct 2015Sterile pyuria is a common entity. Yet there are no guidelines to address this issue. We have conducted a systematic review over 20 years and reviewed the results.... (Review)
Review
Sterile pyuria is a common entity. Yet there are no guidelines to address this issue. We have conducted a systematic review over 20 years and reviewed the results. Guidelines for assessment, diagnosis and management are developed based on these results.
PubMed: 26425144
DOI: 10.1177/1756287215592570 -
The Journal of Pediatrics Feb 2020To determine the point prevalence of bacteriuria and bacteriuria without pyuria in asymptomatic children by a systematic review of the literature. (Review)
Review
OBJECTIVE
To determine the point prevalence of bacteriuria and bacteriuria without pyuria in asymptomatic children by a systematic review of the literature.
STUDY DESIGN
We searched MEDLINE and EMBASE for English-, French-, German-, Italian-, and Spanish-language articles. We included articles reporting data on bacteriuria in asymptomatic children up to 19 years of age who had urine collected by suprapubic bladder aspiration, bladder catheterization, or by 3 consecutive clean catch samples. Two independent reviewers assessed studies for inclusion and abstracted data.
RESULTS
Fourteen studies (49 806 children) were included. The prevalence of asymptomatic bacteriuria was 0.37% (95% CI, 0.09-0.82) in boys and 0.47% (95% CI, 0.36-0.59) in girls. The corresponding values for asymptomatic bacteriuria without pyuria were 0.18% (95% CI, 0.02-0.51) and 0.38% (95% CI, 0.22-0.58), respectively. The subgroups with the highest prevalence of asymptomatic bacteriuria were uncircumcised males <1 year of age and females >2 years of age. In males, the prevalence of asymptomatic bacteriuria after infancy was 0.08% (95% CI, 0.01-0.37). The median duration of asymptomatic bacteriuria in untreated boys and girls, from the one study reporting this outcome, was 1.5 and 2 months, respectively.
CONCLUSIONS
Some clinicians are concerned that when a preverbal child with asymptomatic bacteriuria develops a nonlocalizing febrile illness and presents for evaluation, they may be mistakenly diagnosed as having a urinary tract infection (UTI). Given that the prevalence of asymptomatic bacteriuria is considerably lower than the prevalence of UTI in most subgroups examined, this will occur extremely rarely. These data suggest that the current definition of UTI should be revisited.
Topics: Asymptomatic Infections; Bacteriuria; Child; Global Health; Humans; Prevalence
PubMed: 31787323
DOI: 10.1016/j.jpeds.2019.10.019 -
World Journal of Clinical Pediatrics May 2015Kawasaki disease (KD) is an acute, febrile vasculitis that predominantly develops in children ≤ 5 years of age and can lead to multiple organ injuries including the... (Review)
Review
Kawasaki disease (KD) is an acute, febrile vasculitis that predominantly develops in children ≤ 5 years of age and can lead to multiple organ injuries including the kidneys. Of these injuries, pyuria is a common feature of patients with KD, occurring in 30%-80% of patients. Sterile pyuria is most common in KD patients ≤ 1 year of age. KD patients with sterile pyuria exhibit more severe inflammatory reactions and may have sub-clinical renal injuries. Sterile pyuria in KD is associated with mononuclear cells (not neutrophils) in the urine. Although sterile pyuria in KD was at one time thought to be due to urethritis caused by a non-specific vasculitis of the urethra, recent studies suggest that sterile pyuria in KD originates from the urethra, the kidney as a result of mild and sub-clinical renal injuries, and/or the bladder due to cystitis. Pyuria is not always sterile in KD, but can result from a urinary tract infection (UTI). As causative pathogens, Escherichia coli and Klebsiella oxytoca have been reported. The clinical phenotypes do not differ between those with or without UTI. Because some KD patients with UTIs have urinary tract abnormalities such as vesicoureteral reflux, a complete UTI workup including renal ultrasound, voiding cystourethrogram and/or dimercaptosuccinic acid renal scan recommended in KD patients with UTIs.
PubMed: 26015877
DOI: 10.5409/wjcp.v4.i2.25 -
The Journal of Pediatrics Jan 2023Acute kidney injury occurs frequently during pediatric diabetic ketoacidosis (DKA). We reviewed urinalyses from 561 children with DKA; pyuria was detected in 19% overall... (Review)
Review
Acute kidney injury occurs frequently during pediatric diabetic ketoacidosis (DKA). We reviewed urinalyses from 561 children with DKA; pyuria was detected in 19% overall and in 40% of children with more comprehensive urine testing (≥3 urinalyses) during DKA.
Topics: Child; Humans; Diabetic Ketoacidosis; Pyuria; Diabetes Mellitus, Type 1; Acute Kidney Injury
PubMed: 36084731
DOI: 10.1016/j.jpeds.2022.08.054