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White cells do not equate to bacterial cells in the urine of hospitalized patients
Clinical Question
What is the likelihood that white blood cells in the urine identify bacteria?
Bottom line
Approximately 1-in-7 women and 1-in-38 men walk around with pyuria without bacterial infection. Pyuria, identified in this study by microscopy, is not a good indicator of bacteria in hospitalized people with suspected urinary tract infection; even at a cutoff of 25 cells/high-power field, only approximately half the patients will subsequently have a positive culture. (LOE = 2b)
Overuse alert: This POEM aligns with the Canadian Nurses Association’s Choosing Wisely Canada recommendation: Don’t do a urine dip or send urine specimens for culture unless urinary tract symptoms are present.
Reference
Study design: Cohort (retrospective)
Funding: Industry
Setting: Inpatient (any location)
Synopsis
These investigators identified all adult inpatients (N = 46,127) in a single US hospital system over a 2-year period with a diagnosis of urinary tract infection. For these patients, the authors compared the urine's microscopic white blood cell counts with the presence of any bacteria on urine culture (39.8%). Positive bacterial growth occurred in 33% or less of patients with fewer than 25 cells/high-power field and still only 53.8% of patients with more than 25 cells/high-power field. Using greater than 25 cells/high-power field as a cutoff, the test has a sensitivity 57.6% and a specificity 67.2%.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Pyuria doesn't always mean UTI
Only 1/3 of patients with pyuria had bacteria in their urine. Should not treat on the basis of pyuria alone.
Pyuria and presence of bacteria in hospital patients.
Thanks for this review although it's hard to believe this is still worthy of note. There is lots of supportive literature on this topic. I would go even further and stay this applies equally to long term care patients. And---even if a urine culture is positive in patients who are asymptomatic it does not mean antibiotics are required which means urine cultures should not have been done in the first place since the urge to treat a positive culture is irresistible. "Choosing wisely" wisely has it right!
Urinary White Cells & UTI
Pretty useless piece of information. In-office routine urinalysis is by 'dipstick' which is a muti-test strip. WBC positivity without other positive parameters is not an indication for C&S.
asymptomatic bacturia
don.t treat