P0325FREQUENCY AND PREDICTORS OF NON URINARY INFECTIONS AMONG THE ADULT PATIENTS WITH STERILE PYURIA ATTENDED IN NEPHROLOGY DEPARTMENT OF BSMMU, BANGLADESH

Abstract

Abstract Background and Aims Urinalysis is a test commonly ordered, especially when the patient has a febrile illness. In most cases it provides useful information, but it can sometimes be misleading. A significant proportion of patients with acute febrile illness have transient pyuria without bacteuria. Identification and management of such cases could be improved by better predictive models.To determine predictors of non urinary infections in adult patients with sterile pyuria and to develop a preliminary predictive model. Method This cross sectional study was done in the department of Nephrology, BSMMU, during the period of September 2016 to August 2017. All adult patients with sterile pyuria were included in the study. A total number of 233 cases who had urinary WBCs >5 per high power field (HPF) with a negative culture were selected as sample by convenient sampling technique. We performed detailed clinical and laboratory investigations to identify potential causes of the sterile pyuria. Patients were then divided into two groups, those with causative factors within the urinary tract and those with causative factors outside of the urinary tract. Logistic regression was used to create a model to predict causative group. Results Most 196(84.1%) patients were found to have disorders related to urinary tract (Group A) and 37(15.9%) patients had infections outside of the urinary tract (Group B). Significant proteinuria and urinary casts were more common in Group A, while urinary WBCs>20/hpf and microscopic hematuria were more common in Group(B). All of these differences were statistically significant (p<0.05). In the logistic regression model patients with sterile pyuria with fever (OR 32.9) and/or pyuria with urinary WBC>20/HPF (OR 2.14) were more likely to involvement outside of the urinary tract. Those with urinary tract symptoms (OR 0.28) and/or proteinuria (OR 0.20) were more likely to have renal and urinary tract involvement. Conclusion In patients attended to the nephrology department, sterile pyuria was more likely to have its origin in the urinary tract if there were urinary tract symptoms and/or proteinuria and less likely if there was fever or urinary WBCs >20/hpf. Figure: Diagnosis of the study population (n=233) Figure : Bar diagram shows renal status of the study population P=0.047 P value reached from chi square test Multivariable logistic regression analysis for infections outside the urinary tract