Asymptomatic Pyuria Research Articles

Comparison of Clinical Response to D-Mannose with Behavioral Modifications Versus Behavioral Modifications Alone in Asymptomatic Pyuria During Pregnancy

The physiological and structural changes during pregnancy cause ureteral dilatation and urine stasis, which can lead to asymptomatic and symptomatic infections. Objective: To compare the clinical response between d-mannose with behavioral modifications versus behavioral modifications alone in asymptomatic pyuria during pregnancy. Methods: A quasi experimental study was conducted from April to September 2021, in the Department of Gynecology and Obstetrics Maternal and Child Health Center unit-1, PIMS, Islamabad. A total of 130 women with diagnoses of asymptomatic pyuria matching the inclusion criteria were recruited during study period and assigned to two groups by consecutive non-probability sampling method. Patients with urinary tract abnormalities, GDM, and antibiotic-treated symptomatic UTIs were excluded. Group A was instructed to take 1 g of D-mannose twice daily and follow the advises about behavioral changes.The group B was instrcucted to follow behavioral change only. pus cells in urine R.E.reports were used to evaluate response of treatments. Results: According to the study, the mean age of patients in group A was 27.69 ± 4.04 years, whereas group B had a mean age of 28.85 ± 4.12 years. The majority of patients (61.54%) were aged 15-30. Patients in group A had a mean gestational age of 23.72 ± 3.19 weeks, whereas group B had 24.26 ± 3.23 weeks. Patients had a mean BMI of 29.65 ± 3.55 kg/m2. In group A; 23 (35.18%) and in group B 11 (16.92%) cases of asymptomatic pyuria achieved reolution.Conclusions: This study found that D-mannose with behavioral adjustments resolves asymptomatic pyuria during pregnancy better than behavioral modifications alone.

Impact of altered mental status on antibiotic prescribing and outcomes in hospitalized patients presenting with pyuria

BackgroundPyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance. ObjectivesThe purpose of this study was to evaluate patient outcomes associated with antibiotic treatment of pyuria in patients presenting with AMS at hospital admission without specific urinary tract infection (UTI) symptoms. The primary objective was to compare 30-day readmission rates of patients with pyuria and AMS treated with antibiotics (AMS+Tx) versus those who were not treated (AMS-NoTx). Secondary outcomes included identifying risk factors for antibiotic treatment, comparing alternative diagnoses for AMS, and comparing safety outcomes. MethodsThis retrospective cohort study evaluated adult patients with AMS and pyuria (10 WBC/hpf) admitted between February 1, 2020 and October 1, 2021, in a 350-bed community teaching hospital. Patients with documented urinary symptoms were excluded. Additional exclusion criteria included admission to critical care, history of renal transplant, urological surgery, coinfections, pregnancy, and neutropenia. ResultsTwo-hundred patients were included (AMS+Tx, n = 162; AMS-NoTx, n=38). There was no difference in 30-day hospital readmission rate for AMS between groups (AMS+Tx 16.7% vs AMS-NoTx 23.7%, P = 0.311). An alternative diagnosis of AMS occurred more frequently when antibiotics were withheld (AMS+Tx 66% vs. AMS-NoTx 86.8%, P = 0.012). Urinalyses showing bacteria (odds ratio 2.52; 95% CI, 1.11-5.731) and positive urine culture (OR 3.36; 95% CI, 1.46-7.711) were associated with antibiotic prescribing. ConclusionsInappropriate antibiotic use is common among hospitalized patients presenting with AMS and pyuria; however, treatment of asymptomatic pyuria did not decrease rates of subsequent readmission for AMS or retreatment of symptomatic UTI. Patients who were monitored off antibiotics had higher rates of alternative AMS diagnosis.

Asymptomatic pyuria and bacteriuria are not risk factors for urinary tract infection in women with type 2 diabetes mellitus initiated SGLT2 inhibitors.

Asymptomatic pyuria and bacteriuria are more prevalent in diabetic patients and may be associated with urinary tract infection (UTI). The aim of this study is to investigate the association between asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitor and UTI risk in female patients with type 2 diabetes. The study was designed as a practical, single-center, prospective, cohort study. The female outpatients with type 2 diabetes initiated SGLT2 inhibitor were included. Patients who were symptomatic or treated in the past 3months for urinary or genital tract infection, had a high risk for UTI were excluded. Hospitalization/antibiotic use for indications other than UTI were exclusion criteria during follow-up. All patients were followed up for 3months. Pyuria and bacteriuria were exposure and, UTI was the outcome. Cumulative incidence and relative risk of UTI were analyzed for pyuria and bacteriuria. 143 female patients were included among 1132 female type 2 diabetic patients. 13 patients were excluded during follow-up. 41.5% of the patients (n = 54) had pyuria and 28.5% (n = 37) had bacteriuria. The cumulative incidence of UTI was 20% in the whole cohort, 25,9% (n = 14/54) in the pyuria group and 18.9% (n = 7/37) in the bacteriuria group. The relative risk of UTI was 1.64 (95% CI: 0.82-3.26, p = 0.15) for pyuria, 0.92 (95% CI: 0.42-2.01, p = 0.84) for bacteriuria, and 1.2 (95% CI: 0.47-3.08, p = 0.69) for pyuria plus bacteriuria. Adjusted odd ratios revealed similar results. Asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitors are not risk factors for UTI in women with type 2 diabetes.

Asymptomatic Pyuria as a Prognostic Biomarker in Autosomal Dominant Polycystic Kidney Disease.

Autosomal dominant polycystic kidney disease (ADPKD) has phenotypic variability only partially explained by established biomarkers that do not readily assess pathologically important factors of inflammation and kidney fibrosis. We evaluated asymptomatic pyuria (AP), a surrogate marker of inflammation, as a biomarker for disease progression. We performed a retrospective cohort study of adult patients with ADPKD. Patients were divided into AP and no pyuria (NP) groups. We evaluated the effect of pyuria on kidney function and kidney volume. Longitudinal models evaluating kidney function and kidney volume rate of change with respect to incidences of AP were created. There were 687 included patients (347 AP, 340 NP). The AP group had more women (65% versus 49%). Median ages at kidney failure were 86 and 80 years in the NP and AP groups (log rank, P=0.49), respectively, for patients in Mayo Imaging Class (MIC) 1A-1B as compared with 59 and 55 years for patients in MIC 1C-1D-1E (log rank, P=0.02), respectively. Compared with the NP group, the rate of kidney function (ml/min per 1.73 m2 per year) decline shifted significantly after detection of AP in the models, including all patients (-1.48; P<0.001), patients in MIC 1A-1B (-1.79; P<0.001), patients in MIC 1C-1D-1E (-1.18; P<0.001), and patients with PKD1 (-1.04; P<0.001). Models evaluating kidney volume rate of growth showed no change after incidence of AP as compared with the NP group. AP is associated with kidney failure and faster kidney function decline irrespective of the ADPKD gene, cystic burden, and cystic growth. These results support AP as an enriching prognostic biomarker for the rate of disease progression.

Sustained impact of an antibiotic stewardship initiative targeting asymptomatic bacteriuria and pyuria in the emergency department.

To determine whether a multifaceted initiative resulted in maintained reduction in inappropriate treatment of asymptomatic pyuria (ASP) or bacteriuria (ASB) in the emergency department (ED). Single-center, retrospective study. Beginning in December 2015, a series of interventions were implemented to decrease the inappropriate treatment of ASP or ASB in the ED. Patients discharged from the ED from August to October 2015 (preintervention period), from December 2016 to February 2017 (postintervention period 1), and from November 2019 to January 2020 (postintervention period 2) were included if they had pyuria and/or bacteriuria without urinary symptoms. The primary outcome was the proportion of patients prescribed antibiotics within 72 hours of discharge from the ED. The secondary outcome was the number of patients returning to the ED with symptomatic UTI within 30 days of discharge. We detected a significant decrease in the proportion of patients with ASP or ASB who were inappropriately treated when comparing the preintervention group and post-intervention group 1 (100% vs 32.4%; P < .001). This reduced frequency of inappropriate treatment was noted 3 years after the intervention, with 28% of patients receiving treatment for ASP or ASB in postintervention group 2. (P was not significant fin the comparison with postintervention group 1.) Among the 3 groups analyzed, we detected no difference in the numbers of patients returning to the ED with a symptomatic UTI within 30 days of ED discharge regardless of whether patients received antibiotics. A multifaceted intervention resulted in a significant decrease in inappropriate use of antibiotics for ASP and/or ASB that was maintained 3 years after implementation.

Clinical Profile and Risk Assessment of Infections Among Diabetics in a Community Health Hospital in Chennai: A Hospital Based Descriptive and Cross-Sectional Study

Background: Incidence of diabetes mellitus continues to rise, common focus areas for diabetes control are blood glucose levels, diet, and exercise. Controlling these factors are essential for a better quality of life in diabetes patients. Patients with diabetes have an increased risk of asymptomatic bacteriuria and pyuria, cystitis, and, more important, serious upper urinary tract infection. Materials and Methods: This was a hospital based descriptive and cross-sectional study which included 250 Study subjects who were admitted in CSI Kalyani General hospital during the period from July 2017 to July 2018 and who has Diabetic as a comorbidity were interviewed using structured protocol based proforma. Patient underwent routine clinical, pathological and biochemical investigations. Results: In this study, 250 in-patients were included and analyzed. The prevalence of Infection in Diabetes mellitus was 65.6%. There is no significant association between Age, Education, Occupation, HbA1C, Duration and type of treatment and biochemical values. The commonest organism in Urine sample among the study group was E.coli followed by Klebsiella. UTI is more common in females, Respiratory infection is more common in males and it is statistically significant (p&lt;0.009) and it is statistically significant (p&lt;0.007). Conclusion: From this study, we have concluded that patient with diabetes mellitus is at increased risk for common infections due to poor glycemic control and Obesity. Poor glycemic control suppresses the immunity and more prone for infection. Therefore, the challenges will be to attain good glycemic control, change in lifestyle to maintain normal BMI. This will prevent the morbimortality, reduce the long-term complication and maintenance to prolong the life without any sequele. More prospective case control studies on the management of infections in DM patients are needed. Keywords: type 2 diabetes mellitus, infections, clinical profile, hba1c, glycemic control

51. Sustained Impact of an Antimicrobial Stewardship (AS) Initiative Targeting Asymptomatic Bacteriuria and Pyuria in the Emergency Department (ED)

BackgroundThe sustainability of unique AS initiatives are largely unstudied. A multi-faceted initiative to reduce inappropriate treatment of asymptomatic pyuria (ASP) and asymptomatic bacteriuria (ASB) in the ED was implemented at our institution in 2016. A pre-post intervention analysis demonstrated reduction in the inappropriate treatment (tx) of ASP/ASB from 100% to 32% (p< 0.001) following the intervention. The purpose of this present study was to determine the sustained impact of the initiative and determine if re-education provided in Oct 2020 could further reduce inappropriate tx.MethodsThis was a retrospective, interrupted time series study conducted at an 885 bed academic medical center. Patients (pts) discharged from the ED in Nov 2019 – Feb 2020 (group 1) and Nov 2020 – Feb 2021 (group 2) were retrospectively screened in chronologic order until 50 pts in each group met study criteria. Similar to the 2016 study, pts were included if they were ≥ 18 years old and had a positive urine culture or pyuria. Pts were excluded if they had symptoms of a urinary tract infection (UTI), another infection requiring antibiotics (ABX), indwelling catheter, ureteral stent, or nephrostomy tube, or if pregnant or immunocompromised. The primary outcome was the proportion of pts prescribed ABX within 72 hrs of ED discharge. The secondary outcome was the number of pts returning to the ED with symptomatic UTI within 30 days of discharge. Group 1 was compared to the 2016 study’s post group to determine the sustained impact of the initial initiative; group 2 was compared to group 1 to determine the impact of re-education, which involved a presentation to ED providers and a posted algorithm and fact sheet. ResultsResults from all time periods are summarized in Table 1. Improvement in inappropriate tx was still noted 3 years after the intervention (28% vs 32%; p = NS). Re-education did not further improve inappropriate prescribing, with 28% of group 2 pts still receiving tx.Table 1. ConclusionThe decrease in inappropriate use of ABX for ASP/ASB was still noted 3 years after implementation of a multi-faceted AS initiative. Re-education did not result in further improvement. Disclosures James Johnson, PharmD, FLGT (Shareholder) Vera Luther, MD, Nothing to disclose

Patients with preoperative asymptomatic pyuria are not prone to develop febrile urinary tract infection after ureteroscopic lithotripsy

BackgroundThis study aimed to evaluate the association of asymptomatic pyuria before ureterorenoscopic lithotripsy (URSL) with postoperative febrile urinary tract infection (UTI).MethodsThis 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.ResultsA 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).ConclusionsCompared to the patients with sterile urine prior to URSL, those with asymptomatic pyuria were not prone to develop febrile UTI after URSL.

Should We Delay Urodynamic Study When Patients With Spinal Cord Injury Have Asymptomatic Pyuria?

ObjectiveTo assess the incidence of urinary tract infection (UTI) with post-urodynamic study (post-UDS) in patients with spinal cord injury (SCI) and study its relationship with pre-UDS pyuria.MethodsPatients with SCI who were hospitalized and underwent UDS during a 4-year period were reviewed. Patients with pre-test lower urinary tract symptoms were excluded. Urinalysis and urine culture were performed before and 24 hours after UDS. Prophylactic antibiotics were administered for 5 days starting from the morning of the UDS. UTI was defined as bacteriuria with accompanying symptoms.ResultsOf 399 patients reviewed, 209 (52.4%) had pyuria in pre-UDS urinalysis, and 257 (64.4%) had bacteriuria in pre-UDS culture. Post-UDS UTI occurred in 6 (1.5%) individuals who all complained of fever: 5 (2.4%) of the post-UDS UTI cases occurred in patients with pre-UDS pyuria, and 1 (0.5%) in a person without. The differences between groups were not statistically significant (p=0.218). Of 221 patients with bacteriuria (gram-negative isolates) on pre-UDS culture, resistance to ciprofloxacin, cephalosporin, and trimethoprim/sulfamethoxazole (TMP/SMT) was noted in 52.9% (117 cases), 57.0% (126 cases), and 38.9% (86 cases), respectively.ConclusionNo difference was found in the prevalence of post-UDS UTI based on the presence of pyuria in pre-UDS urinalysis. UDS may be performed even in SCI cases of pre-UDS pyuria without increasing the prevalence of post-UDS UTI if prophylactic antibiotics are administered. TMP/SMT could be used as a first-line antibiotic for the prevention of post-UDS UTI in Korea.

Addressing Antibiotic Overuse in the Outpatient Setting: Lessons From Behavioral Economics

Addressing Antibiotic Overuse in the Outpatient Setting: Lessons From Behavioral Economics

Asymptomatic Pyuria as a Prognostic Factor in Autosomal Dominate Polycystic Kidney Disease

Asymptomatic Pyuria as a Prognostic Factor in Autosomal Dominate Polycystic Kidney Disease

Treatment of asymptomatic pyuria in psychiatric patients discharged from the emergency department following antimicrobial stewardship implementation

AbstractIntroductionAbnormal urinalysis (UA) results, such as pyuria or bacteriuria, increase the risk for antibiotic treatment even in the absence of urinary symptoms. In the emergency department (ED), patients presenting with psychiatric emergencies commonly undergo a medical assessment which includes a UA. We hypothesized that the rate of inappropriate antibiotic treatment for asymptomatic pyuria in the psychiatric medical population would decrease following implementation of an antimicrobial stewardship program (ASP) in the ED.MethodsThis retrospective cohort study compared the treatment of adult patients presenting to the ED for medical assessment during a psychiatric emergency with noted pyuria between three time periods following implementation of an ASP: early ASP (2014), established ASP (2016), and mature ASP (2018). The ASP provided education and routine audit‐and‐feedback focused on reducing urine testing and eliminating treatment of asymptomatic pyuria. The primary end point was to compare rates of inappropriate treatment of asymptomatic pyuria between groups. Secondary end points included comparing appropriate agent selection and duration for patients who were prescribed antibiotics, prescriber documentation, and patient outcomes between groups.ResultsA total of 180 patients with pyuria were included; 60 within each study group with 88.3% being asymptomatic. Inappropriate prescribing of antibiotics for asymptomatic patients at ED discharge decreased over time following ASP implementation (2014 = 40.4%, 2016 = 31.4%, 2018 = 17.6%; P = .036). Additionally, documentation noting a positive UA requiring antibiotic treatment decreased (2014 = 46.7%, 2016 = 40%, 2018 = 26.7%). Of the 62 patients treated with antibiotics, selection of a first‐line agent increased with ASP maturity (2014 = 15.4%, 2016 = 26.1%, 2018 = 69.9%; P = .002).ConclusionInappropriate treatment of asymptomatic pyuria in patients presenting to the ED with psychiatric emergencies decreased significantly over time following implementation of an ASP. EDs may benefit from ASP interventions aimed at decreasing reliance on UA interpretation in this patient population.

Assessment of asymptomatic bacteriuria and sterile pyuria among antenatal attendants in hospitals in northern Ghana

BackgroundAsymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine the occurrence of sterile pyuria and asymptomatic bacteriuria among pregnant women accessing antenatal care at a secondary and tertiary care hospitals in Tamale, northern Ghana.MethodsA cross sectional study was conducted by screening 530 pregnant women with no signs of acute urinary tract infection attending antenatal clinic for a period of 6 months. Midstream urine was collected for microscopy, quantitative urine culture and antibiotic susceptibility testing. Data analysis was carried out using the Statistical Package for Social Sciences version 20.ResultsAsymptomatic bacteriuria was respectively 20 and 35.5% at Tamale Central and Tamale Teaching Hospital out of the 390 and 90 women screened. Sterile pyuria was found among 66% of the 50 women presenting at Tamale Central Hospital. More than 64% of isolates recovered from ASB patients were S. aureus and coagulase negative Staph. (CoNS). Escherichia coli was the dominant species among members of the enterobacteriaceae isolated. Highest susceptibility was recorded against gentamicin and amikacin while most resistance was to Ampicillin, cotrimoxazole, chloramphenicol and nitrofurantoin. Resistance to imipenem and vancomycin were 28.8 and 52%, with strains showing multiple drug resistance of between 81 and 92%.ConclusionThe prevalence of asymptomatic bacteriuria is appreciably higher (20–35.5%) than documented rates in the southern sector of the country. The presence of sterile pyuria which may be an indication of asymptomatic renal impairment and most often overlooked in antenatal management is 66%. Empirical treatment of UTIs at the Tamale Central and Teaching Hospital without confirmation of susceptibility may result in treatment failure. It is necessary to screen and treat pregnant women for ASB and SP due to the complications associated with these conditions.

Prevalence and Clinical Characteristics of Asymptomatic Pyuria in Chronic Kidney Disease.

BackgroundPyuria seems to be common in chronic kidney disease (CKD), irrespective of urinary tract infection (UTI). It has been hypothesized that sterile pyuria occurs in CKD because of chronic renal parenchymal inflammation. However, there are limited data on whether CKD increases the rate of pyuria or how pyuria in CKD should be interpreted. We investigated the prevalence and characteristics of asymptomatic pyuria (ASP) in CKD via urinary white blood cell (WBC) analysis.MethodsUrine examination was performed for all stable hemodialysis (HD) and non-dialysis CKD patients of the outpatient clinic (total N=298). Patients with infection symptoms or recent history of antibiotic use were excluded. Urine culture and WBC analysis were performed when urinalysis revealed pyuria.ResultsThe prevalence of ASP was 30.5% (24.1% in non-dialysis CKD and 51.4% in HD patients). Over 70% of the pyuria cases were sterile. The majority of urinary WBCs were neutrophils, even in sterile pyuria. However, the percentage of neutrophils was significantly lower in sterile pyuria. In multivariate logistic regression analysis, the degree of pyuria, percentage of neutrophils, and presence of urinary nitrites remained independently associated with sterile pyuria.ConclusionsThe prevalence of ASP was higher in CKD patients and increased according to CKD stage. Most ASP in CKD was sterile. Ascertaining the number and distribution of urinary WBCs may be helpful for interpreting ASP in CKD.

The Risk Factors for Asymptomatic Pyuria Among Patients With Type 2 Diabetes

Background: Diabetic patients often develop urinary tract infections (UTI). Diabetic patients are also likely to develop mental illness, and psychotropic drugs have anticholinergic adverse effects such as urinary disturbance. We aimed to elucidate the risk factors of asymptomatic pyuria in patients with type 2 diabetes. Methods: We picked up outpatients with type 2 diabetes who visited the Department of Internal Medicine for the first time, from December 2010 to November 2012 for the treatment of diabetes and completed the questionnaire to obtain the medical history. We obtained clinical information from medical records and questionnaires. Urine leukocytes >= 10/high-power field was defined as pyuria. Comparisons such as pyuria group vs. non-pyuria group and non-mental illness group vs. mood disorder group vs. schizophrenia group were performed. Results: One hundred twenty-one patients were eligible. Sixty-nine were males, 52 were females, mean age was 63 years. There were 48 patients who had mental illness. The duration of diabetes was 5.1 years, hemoglobin A1c (HbA1c) was 8.5%. Prevalence of pyuria was 15.7%. Mean age in non-pyuria group was 62.8 years old, and 65.1 years old in pyuria group. Proportion of female (84%) in pyuria group was significantly higher than non-pyuria group. Patients with pyuria significantly more often had mental illness and psychotropic drugs prescription than patients without pyuria. Duration of diabetes in non-pyuria group was 5.3 years and that in pyuria group was 4.0 years. Coefficient of variations of R-R intervals (CVR-R) in electrocardiogram (ECG), an index of autonomic nervous dysfunction, was 3.2% in non-pyuria group and 1.8% in pyuria group. Pyuria group had significantly higher prevalence of autonomic nervous dysfunction. Coexistence of mental illness and lower CVR-R were associated with risk of pyuria in female diabetic patients. Conclusions: In addition to female sex, autonomic neuropathy and mental illness were significant risk factors for pyuria in patients with type 2 diabetes. To elucidate this association, further studies, preferably with larger numbers of subjects, will be needed. J Endocrinol Metab. 2019;9(6):193-198 doi: https://doi.org/10.14740/jem629

1484. Prevalence of Pyuria With and Without Bacteriuria in Healthy Pre-Menopausal Women

BackgroundPyuria has long been considered key to diagnosis of urinary tract infection in women, but there is a paucity of data on its prevalence and association with asymptomatic bacteriuria (ASB) in healthy women, even though pyuria and ASB often trigger inappropriate antimicrobial treatment.MethodsWe enrolled 104 healthy premenopausal women with a history of recurrent urinary tract infection (UTI) in an observational study and performed daily assessments of bacteriuria, pyuria (leukocyte esterase strips) and UTI symptoms over a 3-month period. These data enabled an evaluation of the prevalence of pyuria and ASB and associations between them.ResultsThe mean age of participants was 22 and 74% were white. Pyuria occurred frequently in this cohort of women, with 72 (77%) of 94 evaluable subjects having pyuria on at least one day with no symptomatic UTI diagnosed. The median percent of days with pyuria reported was 7% (range, 0–100%). Asymptomatic bacteriuria (ASB, urine culture with colony count ≥105 CFU/mL of uropathogen on days with no symptomatic UTI diagnosed) occurred in 45 (45%) women on 159 (2.5%) of 6,283 days. ASB was most commonly caused by E. coli, which was present in 1.4% of days with median duration one day (range, 1–10). The positive predictive value of pyuria in detecting ASB was 4%. Five women had 11 transient episodes of pyuria, significant bacteriuria, and UTI symptoms (“preclinical UTI”) but did not seek medical attention.ConclusionIn this population of healthy women at high risk for UTI and ASB, asymptomatic pyuria was a frequent occurrence and ASB rarely lasted more than 2 days. Pyuria, whether associated with bacteriuria or not, was generally not accompanied by urinary symptoms and did not appear to be clinically meaningful. Young women with recurrent UTI are often advised by their providers to test their urine with dipsticks for pyuria or bacteriuria, and be treated if either are positive, regardless of absence of UTI symptoms. Such practices, which contribute to antimicrobial resistance, are not supported by our data.Disclosures All authors: No reported disclosures.

The risk factors of urinary tract infection after transurethral resection of bladder tumors.

Few studies mention the necessity of antimicrobial prophylaxis (AMP) for transurethral resection of bladder tumor (TURBT) and the risk factors for postoperative urinary tract infections (UTIs) after TURBT. To evaluate the necessity of AMP and to detect the risk of UTIs, we examined the perioperative clinical factors. 687 patients who underwent TURBT between 2006 and 2017 at Hiroshima Prefectural Hospital were examined retrospectively. We defined the postoperative UTIs as febrile UTIs (≥ 38°C). The AMP for the TURBT that we used was mostly cephalosporin generation 1. The association between the perioperative clinical/pathological factors and postoperative UTIs was assessed by logistic regression retrospectively. 21 patients (3.1%) suffered from postoperative UTIs, and almost all of them were successfully treated with the immediate administration of antibiotics. Univariate analysis showed that past pelvic radiotherapy (p = 0.024, odds ratio (OR) 6.00), tumor size (≥ 2cm) (p = 0.008, OR 3.38), age (≥ 75years) (p = 0.036, OR 2.65), preoperative hospital stay (≥ 5days) (p = 0.017, OR 3.76), asymptomatic pyuria (p = 0.038, OR 2.54) and bacteriuria (p = 0.044, OR 2.97) were all associated with postoperative UTIs. We demonstrated that AMP was effective for patients who underwent TURBT, and history of pelvic radiotherapy, high age, preoperative hospital stay and a certain tumor size were the risk factors as well as pyuria and bacteriuria of postoperative UTIs.

The Risk Factors for Asymptomatic Pyuria Among Patients With Type 2 Diabetes

The Risk Factors for Asymptomatic Pyuria Among Patients With Type 2 Diabetes

A CASE OF URETERAL STENT ENCRUSTATION AFTER LAPAROSCOPIC PYELOPLASTY IN AN 11-YEAR-OLD GIRL

Stent encrustation is one of the most serious complications of using double J stents. The management of encrusted stent is challenging, especially in children. To date, only two pediatric cases of stent encrustation, at the expected timing of removal after pyeloplasty, have been reported. In this report, we present a case of ureteral stent encrustation after laparoscopic retroperitoneal pyeloplasty in an 11-year-old girl. She underwent dismembered pyeloplasty for pelvi-ureteric junction obstruction on the left side using a double J stent (6 F, 24 cm, Polaris ™ Ultra). Postoperative course was uneventful, except for mild bladder irritability and asymptomatic pyuria. Nine weeks later, an attempt to remove the stent was made under general anesthesia. This attempt was unsuccessful as the renal coil got stuck in the anastomotic position. A retrograde 6 F flexible ureteroscopy revealed an encrusted stent with calculi. After transurethral lithotripsy with a holmium: yttrium aluminum garnet (YAG) laser, the stent was extracted. Stone analysis showed struvite. At 8-months follow-up, she was stone-free and doing well with resolution of hydronephrosis.

Asymptomatic pyuria in pregnant women during the first trimester is associated with an increased risk of adverse obstetrical outcomes

ObjectiveUrinalysis is included in the prenatal examination in the first trimester in Taiwan, in contrast to Western countries. We aimed to investigate whether asymptomatic pyuria as detected by urinalysis was associated with adverse perinatal outcomes. Materials and MethodsA total of 1187 singleton pregnant women who received prenatal care at Kaohsiung Chang Gung Memorial Hospital between January 2012 and December 2013 were included for retrospective analysis. We defined asymptomatic pyuria as the presence of 15 or more white blood cells/μL in midstream urine without symptoms. Adverse perinatal outcomes including preterm delivery, preterm premature rupture of membrane, low birth weight, and Apgar scores were analyzed. Univariate and multivariate logistic regression analyses were used to identify independent predictors. ResultsThe prevalence of asymptomatic pyuria was 21.3% in our cohort. Univariate analysis showed that pyuria was the only factor associated with preterm delivery before 36 weeks of pregnancy, preterm premature rupture of membrane, and low birth weight. In multivariate analysis, both pyuria (odds ratio: 4.89, 95% confidence interval: 1.80–13.25, p=0.002) and a maternal age of 35 years or older (odds ratio: 3.46, 95% confidence interval: 1.11–10.78, p=0.033) were significant independent predictors for a low 5 minute Apgar score (<7). ConclusionThe identification of asymptomatic pyuria via urinalysis in the first trimester may be a predictor for adverse perinatal outcomes.