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Journal of Yeungnam Medical Science Jan 2022The current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria....
BACKGRUOUND
The current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria. However, we observed that some of the patients who are diagnosed with APN do not have characteristic clinical features or pyuria at the initial examination. We performed this study to investigate the characteristics of APN without pyuria.
METHODS
A retrospective, cross-sectional study was conducted on 391 patients diagnosed with APN based on clinical and radiologic findings, between 2015 and 2019. The clinical features, laboratory results, and computed tomography (CT) findings were compared between patients with normal white blood cell (WBC) counts and those with abnormal WBC counts (WBC of 0-5/high power field [HPF] vs. >5/HPF) in urine.
RESULTS
More than 50% of patients with APN had no typical urinary tract symptoms and one-third of them had no costovertebral angle (CVA) tenderness. Eighty-eight patients (22.5%) had normal WBC counts (0-5/HPF) on urine microscopy. There was a negative correlation between pyuria (WBC of >5/HPF) and previous antibiotic use (odds ratio, 0.249; 95% confidence interval, 0.140-0.441; p<0.001), and the probability of pyuria was reduced by 75.1% in patients who took antibiotics before visiting the emergency room.
CONCLUSION
The diagnosis of APN should not be overlooked even if there are no typical clinical features, or urine microscopic examination is normal. If a patient has already taken antibiotics at the time of diagnosis, imaging studies such as CT should be performed more actively, regardless of the urinalysis results.
PubMed: 34411474
DOI: 10.12701/yujm.2021.01207 -
Journal of Feline Medicine and Surgery Oct 2022A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study...
OBJECTIVES
A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study was to determine the ability of a urinalysis and lower urinary tract signs (LUTS) to predict urine culture results in cats with AKI.
METHODS
Ninety-seven cats with AKI were included in this study. This was a retrospective, observational study. Medical records from 2008 to 2018 were reviewed to identify cats with AKI that had a paired urinalysis and urine bacterial culture. The sensitivity, specificity, positive predictive value and negative predictive values of microscopic bacteriuria, pyuria, hematuria and the presence of LUTS for predicting urine culture results was calculated.
RESULTS
Thirty-two percent of cats (n = 31) had a positive urine culture. Of these, 28 (90%) had bacteriuria, 21 (68%) had pyuria, 13 (42%) had hematuria and 10 (32%) had LUTS. Of the 42 cats without hematuria or pyuria, seven had a positive urine culture (17%). Bacteriuria had a high sensitivity (90%) and specificity (92%) for predicting urine culture bacterial growth. The absence of bacteriuria had a high negative predictive value for no bacterial growth (95%). The odds of a positive urine culture were increased with bacteriuria (odds ratio [OR] 114, 95% confidence interval [CI] 29-621; <0.001), pyuria (OR 21, 95% CI 7-70; <0.001) and LUTS (OR 5, 95% CI 1.7-16; = 0.004). Hematuria was not associated with a positive culture (sensitivity 42%, specificity 52%).
CONCLUSIONS AND RELEVANCE
Microscopic bacteriuria and pyuria on urine sediment evaluation and LUTS can be helpful for predicting bacterial culture results in cats with AKI and in settings where submitting a urine culture may not be financially feasible.
Topics: Acute Kidney Injury; Animals; Bacteriuria; Cat Diseases; Cats; Pyuria; Urinalysis; Urinary Tract Infections; Urine
PubMed: 35748789
DOI: 10.1177/1098612X221105309 -
BMC Urology Nov 2021This study aimed to evaluate the association of asymptomatic pyuria before ureterorenoscopic lithotripsy (URSL) with postoperative febrile urinary tract infection (UTI). (Observational Study)
Observational Study
BACKGROUND
This study aimed to evaluate the association of asymptomatic pyuria before ureterorenoscopic lithotripsy (URSL) with postoperative febrile urinary tract infection (UTI).
METHODS
This observational case-control study identified the patients undergoing URSL for ureteral stones between May 2011 and October 2015. The included patients were classified into two groups: the asymptomatic pyuria group (6-50 white blood cells [WBCs]/high-power field [HPF]) and the non-pyuria group (≤ 5 WBCs/HPF). All data were collected by reviewing medical records. Postoperative outcomes were collected in terms of febrile UTI, emergency visits, and stone-free rate.
RESULTS
A total of 232 patients were included, 101 in the pyuria group, 131 in the non-pyuria group. Two (0.9%) patients developed febrile UTI after URSL and 12 (5.2%) patients visited emergency department for URSL-related symptoms. The overall stone-free rate was 90.9%. There was no significant difference between the pyuria and non-pyuria groups regarding febrile UTI, emergency visits, and stone-free rate. Multivariate analysis revealed that pyuria was neither significantly associated with postoperative febrile UTI (OR = 1.03, 95% CI = 0.06-18.10, P = 0.98), nor with emergency visits (OR = 0.48, 95% CI = 0.13-1.85, P = 0.29).
CONCLUSIONS
Compared to the patients with sterile urine prior to URSL, those with asymptomatic pyuria were not prone to develop febrile UTI after URSL.
Topics: Adult; Asymptomatic Diseases; Case-Control Studies; Female; Fever; Humans; Lithotripsy; Male; Middle Aged; Postoperative Complications; Preoperative Period; Pyuria; Risk Factors; Ureteral Calculi; Ureteroscopy; Urinary Tract Infections
PubMed: 34763689
DOI: 10.1186/s12894-021-00919-z -
International Urogynecology Journal Jul 2018Urinary dipsticks and culture analyses of a mid-stream urine specimen (MSU) at 10 cfu ml of a known urinary pathogen are considered the gold standard investigations for...
INTRODUCTION AND HYPOTHESIS
Urinary dipsticks and culture analyses of a mid-stream urine specimen (MSU) at 10 cfu ml of a known urinary pathogen are considered the gold standard investigations for diagnosing urinary tract infection (UTI). However, the reliability of these tests has been much criticised and they may mislead. It is now widely accepted that pyuria (≥1 WBC μl) detected by microscopy of a fresh unspun, unstained specimen of urine is the best biological indicator of UTI available. We aimed to scrutinise the greater potential of symptoms analysis in detecting pyuria and UTI.
METHODS
Lower urinary tract symptom (LUTS) descriptions were collected from patients with chronic lower urinary tract symptoms referred to a tertiary referral unit. The symptoms informed a 39-question inventory, grouped into storage, voiding, stress incontinence and pain symptoms. All questions sought a binary yes or no response. A bespoke software package was developed to collect the data. The study was powered to a sample of at least 1,990 patients, with sufficient power to analyse 39 symptoms in a linear model with an effect size of Cohen's f = 0.02, type 1 error probability = 0.05; and power (1-β); 95% where β is the probability of type 2 error). The inventory was administered to 2,050 female patients between August 2004 and November 2011. The data were collated and the following properties assessed: internal consistency, test-retest reliability, inter-observer reliability, internal responsiveness, external responsiveness, construct validity analysis and a comparison with the International Consultation on Incontinence Modular Questionnaire for female lower urinary tract symptoms (ICIQ-FLUTS). The dependent variable used as a surrogate marker of UTI was microscopic pyuria. An MSU sample was sent for routine culture.
RESULTS
The symptoms proved reliable predictors of microscopic pyuria. In particular, voiding symptoms correlated well with microscopic pyuria (χ = 88, df = 1, p < 0.001). The symptom inventory has significant psychometric characteristics as below: test-retest reliability: Cronbach's alpha was 0.981; inter-observer reliability, Cronbach's alpha was 0.995, internal responsiveness F = 221, p < 0.001, external responsiveness F = 359, df = 5, p < 0.001. The correlation coefficients for the domains of the ICIQ-FLUTS were around R = 0.5, p < 0.001.
CONCLUSION
This symptoms score performed well on the standard, psychometric validation. The score changed in response to treatment and in a direction appropriate to the changes in microscopic pyuria. It correlated with measures of quality of life. It would seem to make a good candidate for monitoring treatment progress in ordinary clinical practice.
Topics: Bacterial Infections; Female; Humans; London; Lower Urinary Tract Symptoms; Male; Predictive Value of Tests; Psychometrics; Pyuria; Quality of Life; Reproducibility of Results; Surveys and Questionnaires
PubMed: 28971220
DOI: 10.1007/s00192-017-3472-7 -
Journal of Clinical Medicine Aug 2021This study aims to investigate the clinical role of preoperative pyuria for predicting bacillus Calmette-Guérin (BCG) unresponsiveness in non-muscle invasive bladder...
This study aims to investigate the clinical role of preoperative pyuria for predicting bacillus Calmette-Guérin (BCG) unresponsiveness in non-muscle invasive bladder cancer (NMIBC). We performed a logistic regression analysis on 453 patients with NMIBC who were treated with BCG immunotherapy after a transurethral resection of bladder tumours, to evaluate predictive factors of BCG unresponsiveness. We also analysed univariate and multivariable survival data to estimate the prognostic impact of pyuria. Of the total study population, 37.6% (170/453) of patients had BCG unresponsiveness. A multivariable logistic regression analysis revealed that a history of upper urinary tract cancer (odds ratio (OR): 1.86, 95% confidence interval (CI): 1.04-3.32, -value = 0.035) and the presence of pyuria (OR: 1.51, 95% CI: 1.01-2.27, = 0.047) and tumour multiplicity (OR: 1.80, 95% CI: 1.18-2.75, -value < 0.001) were significant predictors of BCG unresponsiveness. A Cox proportional hazards analysis model showed that pyuria was a significant prognostic factor for progression-free survival (hazard ratio: 4.51, 95% CI: 1.22-16.66, = 0.024). A history of upper urinary tract cancer and the presence of pyuria and tumour multiplicity are predictive markers of BCG unresponsiveness. For patients with NMIBC who have preoperative pyuria, treatment using BCG should be considered cautiously.
PubMed: 34501211
DOI: 10.3390/jcm10173764 -
The Cochrane Database of Systematic... Jul 2013Urinary tract infections account for about 40% of hospital-acquired (nosocomial) infections, and about 80% of urinary tract infections acquired in hospital are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Urinary tract infections account for about 40% of hospital-acquired (nosocomial) infections, and about 80% of urinary tract infections acquired in hospital are associated with urinary catheters.
OBJECTIVES
To determine if certain antibiotic prophylaxes are better than others in terms of prevention of urinary tract infections, complications, quality of life and cost-effectiveness in short-term catheterisation in adults.
SEARCH METHODS
We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, and handsearching of journals and conference proceedings (searched 31st October 2012). Additionally, we examined all reference lists of identified trials.
SELECTION CRITERIA
All randomised and quasi-randomised trials comparing antibiotic prophylaxis for short-term (up to and including 14 days) catheterisation in adults.
DATA COLLECTION AND ANALYSIS
Data were independently extracted by all review authors and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systemtic Reviews of Interventions. Where data had not been fully reported, clarification was sought directly from the authors of the trial.
MAIN RESULTS
Six parallel-group randomised controlled trials with 789 participants met the inclusion criteria. All six trials compared antibiotic prophylaxis versus no prophylaxis. Studies presented a low to unclear risk of bias with similar interventions and measured outcomes.The primary outcome of bacteriuria was less common in the prophylaxis group amongst surgical patients with asymptomatic bacteriuria (I(2) = 0; risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) . Two non-surgical studies could not be combined in a meta-analysis due to heterogeneity and only one showed significantly fewer cases of bacteriuria (RR 0.19; 95% CI 0.09 to 0.37).Two trials of surgical patients with asymptomatic bacteriuria only (255 participants) compared one type of antibiotic prophylaxis with another and neither study showed a significant difference in cases of bacteriuria.One study (78 participants) compared antibiotic prophylaxis in patients at catheterisation only versus antibiotic prophylaxis throughout catheterisation period with asymptomatic bacteriuria. Antibiotics at catheterisation only, resulted in significantly fewer cases of bacteriuria than giving prophylaxis throughout the catheterisation period (RR 0.29 95% CI 0.09 to 0.91).Secondary data of pyuria were provided by two surgical studies (255 participants). When studies were pooled, pyuria occurred in significantly fewer cases in the prophylactic antibiotic group (RR 0.23, 95% CI 0.13 to 0.42). The number of gram-negative isolates in patients' urine just before catheter removal in one study (RR 0.05, 95% CI 0.00 to 0.79) and six weeks after hospital discharge (RR 0.36, 95% CI 0.23 to 0.56) were significantly lower. There were no events in the treatment group before catheter removal. When pooled data from two studies showed significantly reduced febrile morbidity in those receiving antibiotic prophylaxis (RR 0.53 95% CI 0.31 to 0.89).Although all studies assessed micro-organisms isolated from the urine specimens the data were too heterogenous to pool in a meta-analysis and have been provided in a narrative form. Further secondary data such as economic analysis, length of stay and quality of life were not covered in detail.
AUTHORS' CONCLUSIONS
The limited evidence indicated that receiving prophylactic antibiotics reduced the rate of bacteriuria and other signs of infection, such as pyuria, febrile morbidity and gram-negative isolates in patients' urine, in surgical patients who undergo bladder drainage for at least 24 hours postoperatively. There was also limited evidence that prophylactic antibiotics reduced bacteriuria in non-surgical patients.
Topics: Adult; Antibiotic Prophylaxis; Catheters, Indwelling; Drainage; Humans; Randomized Controlled Trials as Topic; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections
PubMed: 23824735
DOI: 10.1002/14651858.CD005428.pub2 -
Infectious Diseases in Obstetrics and... 2001Dysuria is a common presenting complaint of women and urinalysis is a valuable tool in the initial evaluation of this presentation. Clinicians need to be aware that... (Review)
Review
Dysuria is a common presenting complaint of women and urinalysis is a valuable tool in the initial evaluation of this presentation. Clinicians need to be aware that pyuria is the best determinate of bacteriuria requiring therapy and that values significant for infection differ depending on the method of analysis. A hemocytometer yields a value of > or = 10 WBC/mm3 significant for bacteriuria, while manual microscopy studies show > or = 8 WBC/high-power field reliably predicts a positive urine culture. In cases of uncomplicated symptomatic urinary tract infection, a positive value for nitrites and leukocyte esterase by urine dipstick can be treated without the need for a urine culture. Automated urinalysis used widely in large volume laboratories provides more sensitive detection of leukocytes and bacteria in the urine. With automated microscopy, a value of > 2 WBC/hpf is significant pyuria indicative of inflammation of the urinary tract. In complicated cases such as pregnancy, recurrent infection or renal involvement, further evaluation is necessary including manual microscopy and urine culture with sensitivities.
Topics: Female; Humans; Urinalysis; Urinary Tract Infections
PubMed: 11916184
DOI: 10.1155/S1064744901000412 -
BMC Pediatrics Apr 2005Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of... (Review)
Review
BACKGROUND
Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture.
METHODS
We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age.
RESULTS
The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful.
CONCLUSION
Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation.
Topics: Child, Preschool; Humans; Infant; Kidney; Predictive Value of Tests; Reagent Strips; Urinalysis; Urinary Tract Infections; Urine
PubMed: 15811182
DOI: 10.1186/1471-2431-5-4 -
Journal of Cardiovascular Imaging Dec 2018Kawasaki disease (KD) sometimes presents with only fever and cervical lymphadenopathy before other clinical signs materialize. This lymphadenopathy-first-presenting...
BACKGROUND
Kawasaki disease (KD) sometimes presents with only fever and cervical lymphadenopathy before other clinical signs materialize. This lymphadenopathy-first-presenting Kawasaki disease (LKD) may be misdiagnosed as bacterial cervical lymphadenitis (BCL). We investigated characteristic imaging and clinical data for factors differentiating LKD from BCL.
METHODS
We compared imaging, clinical, and laboratory data of patients with KD and BCL. We included patients admitted to a single tertiary center between January 2015 and July 2018.
RESULTS
We evaluated data from 51 patients with LKD, 63 with BCL, and 218 with typical KD. Ultrasound imaging revealed multiple enlarged lymph nodes in both LKD and BCL patients. On the other hand, computed tomography (CT) showed more abscesses in patients with BCL. Patients with LKD were younger and showed higher systemic and hepatobiliary inflammatory markers and pyuria than BCL patients. In multivariable logistic regression, younger age and higher C-reactive protein (CRP) retained independent associations with LKD. A comparison of the echocardiographic findings in LKD and typical KD showed that patients with LKD did not have a higher incidence of coronary artery abnormalities (CAA).
CONCLUSIONS
LKD patients tend to have no abscesses on CT and more elevated systemic hepatobiliary inflammatory markers and pyuria compared to BCL patients. The absence of abscess on CT, younger age, and elevated CRP were the most significant variables differentiating LKD from BCL. There was no difference in CAA between LKD and typical KD.
PubMed: 30607392
DOI: 10.4250/jcvi.2018.26.e29 -
Journal of Clinical Microbiology Apr 2020This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic... (Review)
Review
This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic bacteriuria is defined as two consecutive voided specimens (preferably within 2 weeks) with the same bacterial species, isolated in quantitative counts of ≥10 CFU/ml in women, including pregnant women; a single voided urine specimen with one bacterial species isolated in a quantitative count ≥10 CFU/ml in men; and a single catheterized urine specimen with one or more bacterial species isolated in a quantitative count of ≥10 CFU/ml in either women or men (or ≥10 CFU/ml of a single bacterial species from a single catheterized urine specimen). Any urine specimen with ≥10 CFU/ml group B is significant for asymptomatic bacteriuria in a pregnant woman. Asymptomatic bacteriuria occurs, irrespective of pyuria, in the absence of signs or symptoms of a urinary tract infection. The two groups with the best evidence of adverse outcomes in the setting of untreated asymptomatic bacteriuria include pregnant women and patients who undergo urologic procedures with risk of mucosal injury. Screening and treatment of asymptomatic bacteriuria is not recommended in the following patient populations: pediatric patients, healthy nonpregnant women, older patients in the inpatient or outpatient setting, diabetic patients, patients with an indwelling urethral catheter, patients with impaired voiding following spinal cord injury, patients undergoing nonurologic surgeries, and nonrenal solid-organ transplant recipients. Renal transplant recipients beyond 1 month posttransplant should not undergo screening and treatment for asymptomatic bacteriuria. There is insufficient evidence to recommend for or against screening of renal transplant recipients within 1 month, patients with high-risk neutropenia, or patients with indwelling catheters at the time of catheter removal. Unwarranted antibiotics place patients at increased risk of adverse effects (including diarrhea) and contribute to antibiotic resistance. Methods to reduce unnecessary screening for and treatment of asymptomatic bacteriuria aid in antibiotic stewardship.
Topics: Antimicrobial Stewardship; Bacteriuria; Child; Female; Humans; Laboratories; Male; Pregnancy; Pyuria; Urinary Tract Infections
PubMed: 32051261
DOI: 10.1128/JCM.00518-18