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Asymptomatic Bacteriuria
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Pyuria is the presence of white blood cells in the urine and may indicate an inflammatory process in the urinary tract. Pyuria in the presence of bacteriuria therefore does not automatically indicate urinary tract infection, especially in asymptomatic bacteriuria. Even in cystitis, persistent pyuria may have another cause, i.e. renal tuberculosis and sexually transmitted diseases, or be non-infectious, such as interstitial nephritis. Thus, by itself, the presence of pyuria is not sufficient to diagnose bacteriuria, and the presence or absence of pyuria does not differentiate symptomatic from asymptomatic urinary infection. Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment.
Antibiotic Therapy of Multidrug Resistant Organisms in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The clinical approach begins with clinical correlation, i.e., assessing the degree/intensity of pyuria with the urine colony count. Urinalysis (UA) with microscopic (not dipstick UA) with minimal pyruia (<10 WBC/hpf) indicates colonization (CAB), regardless of urine colony count, and such patients should not be treated. If the pyuria is intense, the indwelling urinary catheter should be removed/replaced and the UA/UC repeated and re-assessed in 24 hours. Urinary catheter replacement is often “curative” of itself. If pyuria >10 WBC/hpf persists, treatment should be considered, especially in compromised hosts that may be prone to urosepsis, e.g., diabetes mellitus (DM) [10] (Tables 34.3 and 34.4).
Complications related to neurogenic bladder dysfunction I: Infection, lithiasis, and neoplasia
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Pyuria is “the presence of white blood cells (WBCs) in the urine.” It is generally indicative of an inflammatory response of the urothelium to bacterial invasion. Pyuria alone is not diagnostic of infection, because it may occur from the irritative effect of a urinary catheter, especially if it is at a low level of less than or equal to 30 WBC/HPF (high-power field). More than 50 WBC/HPF is an indicator of high-level pyuria and has been associated with increased morbidity. Bacteriuria without pyuria indicates bacterial colonization rather than infection.2
A Differential Immune Modulating Role of Vitamin D in Urinary Tract Infection.
Published in Immunological Investigations, 2022
Ninety women 20–60 years of age with UTI and 45 age-matched healthy women as the control group were included in the study. Lower UTI was diagnosed by the presence of typical UTI symptoms (dysuria, urgency and frequency of urination, suprapubic pain, and irritability), pyuria [defined as ≥10 white blood cells per high power field (hpf)] in the midstream urine samples examination, and positive urine culture with ≥105 cfu/ml of a single uropathogen. Sixty-five of these patients (72.2%) had E.coli isolated from their urine samples and they were selected for further analyses. The rest were S. saprophyticus (11.2%), S. aureus (4.4%), E. aerogenes (2.2%), K. pneumonia (2.2%), Proteus mirabilis (3.3%), and Enterococci (4.5%). The main exclusion criteria were the use of corticosteroid drugs, antibiotic therapy, vitamin D supplementation, pregnancy, renal failure, gastrointestinal disease, kidney stones, anemia, and any complicating illness (e.g., diabetes, cancer, and urinary tract obstruction). The ethical approval of the study was made through the institutional local ethics committee (IR.IAU.TABRIZ.REC.1396.83). An informed consent was signed by each individual.
Immune thrombocytopenia following multisystem inflammatory syndrome in children (MIS-C) – a case series
Published in Pediatric Hematology and Oncology, 2021
Eric Y. Kok, Lakshmi Srivaths, Amanda B. Grimes, Tiphanie P. Vogel, S. Kristen Sexson Tejtel, Eyal Muscal
In the ED he had temperature of 100.9 °F, heart rate 176 beats per min, respirations 24 per min, O2 saturation 99%, and blood pressure 99/68 mmHg. He had an otherwise normal cardiopulmonary and abdominal exam. His cervical adenopathy was again documented and his rash further characterized as feeling of “sandpaper.” He did not have rhinorrhea or mucocutaneous changes, and his conjunctivitis had resolved. SARS-CoV-2 real-time PCR was positive, and serology was positive for IgG to SARS-CoV-2, IgM was non-reactive. Laboratory evaluation revealed a leukocyte count of 16.9 × 103/µL with absolute neutrophil count of 13.25 × 103/µL and lymphocyte count of 2.12 × 103/µL, hemoglobin 11 g/dL, and platelets 343 × 103/µL (down-trending to 202 over the next 4 days). CRP was 56 mg/L, ESR was 30 mm/hr, ferritin was 63 ng/ml, and D dimer was 0.55 µg/ml. Urinalysis showed sterile pyuria. Troponin was not elevated, but N-terminal-pro-B-type natriuretic peptide (NT-proBNP) was elevated at 5570 pg/mL. Rheumatology and cardiology services were consulted, and echocardiogram revealed mild dilation of the aortic root and left circumflex coronary artery, an irregular appearing left anterior descending coronary artery measuring at the upper limit of normal, and normal biventricular systolic function. He was diagnosed with MIS-C and admitted to the cardiovascular ICU secondary to myocarditis.
Urinary vanin-1 for predicting acute pyelonephritis in young children with urinary tract infection: a pilot study
Published in Biomarkers, 2021
Grażyna Krzemień, Małgorzata Pańczyk-Tomaszewska, Elżbieta Górska, Agnieszka Szmigielska
The following clinical data were collected: age (months), sex, the presence and duration of fever (days) before the admission to the hospital. Fever was defined as body temperature of at least 38.0 °C within 24 hours of presentation. On admission, laboratory workup including urinalysis, urine culture, serum creatinine (Cr), white blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT) was performed. Urinalysis and urine culture were obtained by bladder catheterization. UTI diagnosis was based on the presence of both pyuria and positive urine culture. Pyuria was defined as ≥ 5 WBCs/high powered field on a centrifuged specimen of urine. Significant bacteriuria was defined as pure bacterial growth ≥50.000 colony-forming units/mL or ≥10.000 CFU/mL, if concomitant fever and pyuria were present (Subcommittee on Urinary Tract Infection 2016). Biochemical variables were measured using VITROS 5600 Integrated System (Ortho Clinical Diagnostics), except PCT (Vidas PC Blue, Biomerieux), and WBC count in blood was examined by Sysmex XN-1000 SA-01 (Sysmex). Normal values of indices were as follows: serum Cr ≤0.4 mg/dL:, CRP ≤1.0 mg/dL, PCT <0.05 ng/mL, and WBC count (number of cells/mm3) according to the age.