Significant Pyuria Research Articles

Pyuria in hospitalized general medical patients without urinary tract infection.

Urine microscopy for detecting pus cells is a common investigation ordered in hospitalized general medical patients as part of routine care. A few previous studies have shown that sterile pyuria is not uncommon in this population. We studied the prevalence of pyuria among patients hospitalized with non-urinary tract infection (UTI) diagnosis in the medical wards. We excluded patients with asymptomatic bacteriuria (ASB). Pyuria was quantified in uncentrifuged urine using the chamber counting method, and ≥ 10 pus cells per mm 3 was considered significant. We also compared this method with the commonly used but less accurate method of counting pus cells/high power field using centrifuged urine (routine method). We studied 196 patients; 113 (57.7%) were males. Most (175[89.3%]) patients were hospitalized for an infection. We found that 18.4% of the study group had sterile pyuria, and it was strongly associated with the presence of concomitant microscopic hematuria (unadjusted odds ratio, 3.74 [1.65 to 8.50]; P=0.002). We found no association of pyuria with female gender, diabetes, acute kidney injury, or current antibiotic use. By routine method, 56 (28.6 %) patients had significant pyuria. In comparison to the chamber counting method, the routine method was 69.4(63-75.8) % sensitive and 80.6(75.1-86.2) % specific. The positive and negative predictive values were 44.6 (37.7- 51.6) % and 92.1 (88.4 - 95.9) %. We concluded that sterile pyuria and microscopic hematuria could be present in a proportion of hospitalized general medical patients without UTI or ASB. Clinical judgment is essential in interpreting the significance of abnormal urinalysis reports.

Pyuria in hospitalized general medical patients without urinary tract infection

Urine microscopy for detecting pus cells is a common investigation ordered in hospitalized general medical patients as part of routine care. A few previous studies have shown that sterile pyuria is not uncommon in this population. We studied the prevalence of pyuria among patients hospitalized with non-urinary tract infection (UTI) diagnosis in the medical wards. We excluded patients with asymptomatic bacteriuria (ASB). Pyuria was quantified in uncentrifuged urine using the chamber counting method, and ≥ 10 pus cells per mm3 was considered significant. We also compared this method with the commonly used but less accurate method of counting pus cells/high power field using centrifuged urine (routine method). We studied 196 patients; 113 (57.7%) were males. Most (175[89.3%]) patients were hospitalized for an infection. We found that 18.4% of the study group had sterile pyuria, and it was strongly associated with the presence of concomitant microscopic hematuria (unadjusted odds ratio, 3.74 [1.65 to 8.50]; P=0.002). We found no association of pyuria with female gender, diabetes, acute kidney injury, or current antibiotic use. By routine method, 56 (28.6 %) patients had significant pyuria. In comparison to the chamber counting method, the routine method was 69.4(63—75.8) % sensitive and 80.6(75.1—86.2) % specific. The positive and negative predictive values were 44.6 (37.7— 51.6) % and 92.1 (88.4 — 95.9) %. We concluded that sterile pyuria and microscopic hematuria could be present in a proportion of hospitalized general medical patients without UTI or ASB. Clinical judgment is essential in interpreting the significance of abnormal urinalysis reports.

The Headache of Post-Transurethral Prostate Surgery Pyuria: Pursuit for Evidence.

Objective: To prospectively assess early post-transurethral prostate surgery (TUPS) urinalysis changes and bacteriuria with its clinical relevance. Methods: Patients with benign prostate obstruction enrolled for TUPS were prospectively assessed. Patients were assessed at 2, 4, 8, 12, and 24 weeks postoperatively by the dysuria-visual-analogue-scale (DVAS), international prostate symptom scores (IPSS)-quality of life, uroflow, and postvoid residual. Routine urinalysis was performed before discharge and at all visits. Midstream urine culture (MSUC) was performed before discharge, and 4 and 12 weeks postoperatively. Results: At final analysis, 152 patients were evaluable. Significant pyuria was reported in 52%, 96.1%, 94.1%, 71.7%, 78.9%, and 52.5% in, before discharge, 2-, 4-, 8-, 12-, and 24-week urinalysis postoperative, respectively. The mean time to nonsignificant pyuria (95% confidence interval [CI]) was 19.1 (17.5-20.7), 20.1 (17.3-22.9), 15.8 (12.8-18.8), and 14 (10.3-17.8) weeks after prostate resection, vaporization, enucleation, and incision, respectively (p = 0.03). Regardless the TUPS technique, half of patients had significant pyuria at 24 weeks postoperative. MSUC was positive in 37/152 (24.3%), 3/152 (2%), 23/152 (15.1%), and 5/152 (3.3%) preoperatively, before discharge, and 4 and 12 weeks postoperative, respectively. Only positive preoperative urine leukocyte esterase independently predicted positive 4-week MSUC (odds ratio 3.8, 95% CI 1.3-11.1, p = 0.013). No significant correlation was found between IPSS or DVAS and positive MSUC, nor between IPSS and postoperative pyuria at different follow-up points (p > 0.05). However, the degree of postoperative dysuria was significantly correlated with postoperative pyuria count by urinalysis at 2 weeks (r = 0.69, p = 0.03), 8 weeks (r = 0.26, p = 0.001), and 12 weeks (r = 0.23, p = 0.004). Conclusion: There is a persistent but gradually declining pyuria and microhematuria following TUPS up to 6 months postoperative. An earlier resolution was noted following prostate incision and enucleation. While routine urine analysis screening in these months would be of no clear clinical value, a routine urine culture would be of a reasonable significance at 1 month postoperatively.

Proportion of Urinary Tract Infection in Children between 6 Months to 5 Years of Age Presenting with Fever

Purpose: Fever serves as the most frequent cause of visits to emergency/outpatient pediatric departments among children under the age of five. Very frequently, the youngster is given antibiotics on an arbitrary basis without receiving the proper examination for a urinary tract infection (UTI). This study’s goals were to assess the prevalence of UTIs in febrile children between 6 months and 5 years of age. To study the proportion of UTIs in children between 6 months and 5 years presenting with fever. To study the association of various risk factors with UTI. Methodology: This Cross-sectional Descriptive observational research was done in the Pediatric department of tertiary care hospital from August 2020 to December 2022, in febrile kids between 6 months and 5 years age group using different variables. Association between two qualitative variables was seen by using Chi-square/Fischer’s exact test. A P < 0.05 was considered statistically significant whereas a P < 0.001 was considered highly significant. Results: Among the total study population, it was found that 5.58% of the patients with fever without focus had a UTI, while the majority of patients, 94.42% did not have a UTI but had fever without a specific focus. In UTI cases, urine culture growth patterns showed the presence of different isolates, including Escherichia coli (30.43%), Klebsiella (56.52%), Pseudomonas aeruginosa (8.7%), and Candida (4.34%). Conclusion: In the present research, the overall occurrence of UTI in children <5 years with fever without focus was 5.58%. Patients with significant pyuria and positive urine culture (UTI) were 43.75% and with significant pyuria but the sterile culture was 56.25%. So, it is concluded that significant pyuria can be sterile pyuria and cannot be labeled as UTI without confirmation on the urine culture report.

Fever, Significant Pyuria and A Positive Urine Culture not Always A Urine Infection (UTI)

Fever, Significant Pyuria and A Positive Urine Culture not Always A Urine Infection (UTI)

Drug utilization study of urinary tract infections in obstetrics and gynecology department

Background: The aim of study was to determine the utilization pattern of antimicrobial agents in obstetrics and gynaecology department. Antimicrobial agents are one of the most commonly used drugs word wide and has main contribution in human health system. UTI infection is one of the most widespread bacterial infections of genitourinary tract which can be treated by AMAs. The main aim of this study is; to identify the pattern of drug utilisation of antimicrobials in prescriptions, to analyse the utilisation of different classes of drugs and to identify the outcome of the treatment. Methods: This prospective, observational and analytical study was conducted in patients of obstetrics and gynaecology department of MMIMSR, Mullana after obtaining approval from institutional ethical committee. Demographic data, medical history, prescribed treatment details (drug name, dose, frequency, dosage form etc) and diagnosis, type of UTI, laboratory investigations and outcome of treatment was evaluated. Results: A total 242 female patients were registered, out of which 200 were included in the study as 42 were dropouts. Majority of female patients were belonging to the age group of 18-37 (63%). Most of the female patients had uncomplicated UTI 188 (94%) (p value=0.35), 186 (93%) had significant pyuria and 64 (32%) had urine culture positive (p value= 0.01). Burning micturation and frequency were the most common symptoms observed in 146 (73%). In the study 67(33.5%) females were pregnant and 133 (66.5%) were non pregnant (p value= 0.01). Out of 200 patients 64 (32%) had positive urine cultures and 136 (68%) had negative urine culture reports. E. coli 28 (14%) was the most common bacteria isolated followed by Klebsiella 16 (8%). Average number of drugs prescribed per prescription to non-pregnant was 3.97 and to pregnant were 4.67. In majority of prescriptions, the drugs were prescribed by oral routes (51%) and most of the drugs prescribed were generic (57%). Most of the patients (93%) were recovered from UTIs in 5-7 days of treatment. Conclusions: Our study concluded that the uses of AMAs for UTI were found to be rational and according to the causative organism and susceptibility pattern.

Woman With Frequent Dysuria

A 71-year-old woman with hypertension and diabetes mellitus presented to the emergency department with a 1-day history of dysuria, hematuria, and urinary frequency. During the previous 1 year, she had had several episodes of urinary tract infection. Urinalysis revealed significant pyuria and hematuria. In addition, point-of-care ultrasonography showed a cyst lesion abutting the urinary bladder (Figure 1 and Video). Subsequent abdominal computed tomography was performed (Figure 2).

A Study On Clinical Profile of Urinary Tract Infection in Diabetes Mellitus in a Tertiary Care Hospital

Background: Diabetic Patients are at high risk of developing various infections especially if the diabetes is uncontrolled. Urinary tract infections (UTI) are one of the common infections in diabetics. Knowledge about the clinical and microbiological profile of UTI in diabetic patients will not only aid in early diagnosis but also helps in early initiation of appropriate empirical antibiotic therapy ensuring early recovery. Material & Methods: Prospective hospital based observational study. The study was conducted in the In-patient department, Department of General medicine at KMCT Medical college, Manassery, Kozhikode, Kerala, India. This study was conducted in 170 Diabetic patients above 18 years of age with symptoms of UTI with significant pyuria who were admitted under department of General Medicine, KMCT medical college, Kerala, who satisfied the inclusion criteria and gave consent for study. study consisted a total of 170subjects. Simple Random sampling method. Results: Fever was the most common clinical presentation followed by dysuria. E. coli was the most commonly isolated organism followed by Klebsiella. Most of the organisms were sensitive to Amikacin. Antibiotic resistance and Pyelonephritis were higher in patients with poor glycaemic control. The most common ultrasonographic abnormality was prostatomegaly. Conclusion: Patients with poor glycaemic control are at high risk of resistant UTI and Pyelonephritis. Good glycaemic control with routine monitoring of HbA1C is mandatory in diabetic patients to prevent UTI and to avoid its complications. E. coli was the most common organism isolated followed by Klebsiella. Most of the organisms were sensitive to Amikacin. Hence, Amikacin can be recommended as empirical antibiotic forDiabetic patients who are admitted with UTI.

Massive Hydronephrosis, Countless Lithiasis and Upper Urinary Tract Carcinoma

A 51-year-old otherwise healthy man presented to the emergency department with a 6-month history of weight loss, asthenia, lumbar pain and hematuria. Urinalysis was notable for hematuria without significant pyuria. Hemoglobin was 10.3 g/dL and serum creatinine was 1.2 mg/dL. The remainder of the complete blood count, metabolic panel, and coagulation parameters were normal. An abdominal x-ray was done (Figure 1) and based on the findings of this a computed tomography scan was performed (Figure 2).

Prevalence of urinary tract infection and sensitivity pattern in febrile children less than 5 years of age

Background: Fever has long been considered as an important clinical finding in children with urinary tract infections (UTIs), it is often ignored in children in whom the symptoms are fuzzy. UTI in children is alarming because of the acute and chronic complications not seen routinely in adults. The study emphasizes that UTI should be strongly suspected in febrile children to prevent future complications. This study was undertaken to determine the prevalence of UTI and sensitivity pattern in febrile children and to assess the validity of microscopic urine analysis against urine culture in the diagnosis of UTI.Methods: A descriptive study was undertaken in the department of pediatrics, NMCTH, Birgunj. Data related to age, sex, nutritional status, socioeconomic status were noted. Physical examinations with relevant investigations were carried out in all those patients.Results: Out of 1074 children 147 showed significant pyuria (13.7%) and 44 showed significant bacterial growth making an overall prevalence of 4.1%. Urine cultures were done in all the cases and showed positive culture in 29.93%. Among culture positive cases gram negative organisms were commonly isolated. E. coli (70.45%) commonly isolated in the culture was found highly sensitive to cefotaxime and sulphamethoxazole /trimethoprim (32.14%) and was highly resistance to cefepime, cefuroxime, cefixime.Conclusions: Overall prevalence of UTI in our study was low (4.1%). The >5 pus cells/hpf in centrifuged sample should be considered as significant pyuria and further evaluation should be done promptly to initiate treatment and to prevent long term sequalae.

Egyptian pediatric clinical practice guidelines for urinary tract infections in infants and children (evidence based)

BackgroundNational evidence-based recommendations for diagnosis, treatment, imaging, and follow-up in urinary tract infection are crucial being a major health problem in pediatrics. Every region should follow international recommendations with respect to the disease local profile and available facilities for that area.MethodsBased on AGREE II (the assessment tool of practice guidelines), Egyptian CGLs used *American Academy Pediatrics, *European Association Urology, European Society Pediatric Urology, and *Asian Association Urinary tract infections as its evidence-based references. Health questions were listed for evidence base answers adopted from selected CGLs after their permission. Key statements were approved by all members and further approved by the Egyptian Pediatric Guidelines Committee after local and international external peer reviewing.Results(1) Diagnosis recommendations: Urine culture with diagnostic colony counts is essential for diagnosis. Catheter samples are important for critical cases and non-toilet-trained cases especially when they show significant bacteriuria and pyuria. (2) Treatment plan included areas of debate as choice of antibiotic, oral versus intravenous, duration, antibiotic prophylaxis considering age, disease severity, recurrence, + risk factors, and imaging reports. (3) Imaging recommendations were tailored to suit our community. Renal bladder ultrasound is important for children with febrile UTI, due to the high prevalence of congenital anomalies of the kidney and urinary tract, paucity of prenatal ultrasound, and lack of medical documentation to reflect previously diagnosed UTI or US reports. We recommend renal isotopic scan and voiding cystography for serious presentation, high-risk factors, recurrence, and abnormal US. (4) Urological consultation is recommended: in urosepsis or obstruction, male infants < 6 months. Acute basal DMSA is recommended in congenital renal hypodysplasia. Six months post-infection, US and DMSA are recommended in severe pyelonephritis and vesico-ureteric reflux, where those with abnormal US or DMSA or both should have voiding cystography. (5) Follow-up recommendations include family orientation with hazards of noncompliance and monitoring at pregnancy.ConclusionDiagnosis and treatment show strong recommendations. Imaging depends on patient assessment. Referral to a pediatric nephrologist and urologist in complicated cases is crucial. Follow-up after the age of 16 years in adult clinics is important.

Urinary tract infection in nephrotic syndrome in pediatric age group: a hospital based cross-sectional study

Background: Nephrotic syndrome, characterized by the presence of heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia, is a common renal disorder in pediatric population. Aim of this study were to find out the prevalence of Urinary Tract Infection (UTI) in nephrotic syndrome, bacterial etiologies and antibiotic sensitivity pattern.Methods: After matching the criteria, 82 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture. This is an institution based cross-sectional descriptive observational study. All newly diagnosed and relapse cases of nephrotic syndrome based on inclusion exclusion criteria was included in this study. Respondent was either of the parents or caregiver of the study subjects. Analysis of all data was done by appropriate statistical software (SPSS-23).Results: Among 82 participants evaluated with nephrotic syndrome 29.3% participants had UTI, majority 66.7% were asymptomatic and 33.3% were symptomatic. Significant microscopic hematuria were found in 20.7% study subjects and significant pyuria were found in 58.54% study subjects. Majority of UTI caused by E.coli 33.3% followed by Klebsiella 25%, Proteus 16.7%, Staphylococcus aureus 12.5%, Citrobacter, Acinetobacter and mixed growth were found in 4.2% each. Mean serum cholesterol of group with UTI was 422.13±34.65 and group without UTI was 307.43±26.13. The variation amongst the two groups were found to be significant (p=0.0001).Conclusions: The children with nephrotic syndrome are frequently predisposed to UTI and in most cases it is asymptomatic, often undiagnosed. Higher serum cholesterol level may predispose the nephrotic child for UTI.

Evaluation of Matrix Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry in Direct Identification of Bacteriuria from Urine samples

AbstractObjective: The use of matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI) directly on urine can significantly improve turnaround time for diagnosing urinary tract infection (UTI). The present study was planned to compare the performance of MALDI directly on urine samples with conventional urine culture and evaluate an algorithm using a combination of significant pyuria and MALDI directly on urine samples as a screening method for diagnosing UTI. Materials and Methods: A total of 1000 urine samples from patients with symptoms suggestive of UTIs were analysed. Urine microscopy, urine culture and MALDI were performed simultaneously on all the samples. Results: MALDI correctly identified the microorganisms in 73.83% monomicrobial samples. In culture showing a mixed growth of two and more than three organisms, MALDI was able to identify one microorganism in 27.58% and 15.78% of samples, respectively. There were no peaks by MALDI in 93.53% of 464 sterile samples. The sequential algorithm using urine microscopy and MALDI could correctly identify UTI in 66.23% cases. Conclusion: MALDI can be utilised to rule out bacteriuria in >93% of sterile urine samples. The combination of significant pyuria and direct MALDI as screening method to diagnose UTI (whether monomicrobial or polymicrobial) was not found to be superior than using direct MALDI on urine samples alone.

Study of prevalence of urinary tract infection in febrile children less than 5 years of age

Background: Fever is the most common reason for children under 5 years of age to visit the OPD. Unlike other foci of infection, only a little attention has been focused on the identification of UTI in febrile children. Quite often child receives antibiotics empirically without adequate evaluation of UTI. To determine the prevalence of UTI in all febrile children, from 2 months to 5years of age.Methods: The study included children admitted with bronchiolitis in between during the period of December 2018 to March 2019 at Department of Pediatrics, Raja Muthiah Medical College and Hospital. Totally 200 consecutive children from 2 months to 5 years admitted in the pediatric department Data related to age, sex, predisposing factors will be noted. Urine analysis and urine culture have to be done in all these patients. USG abdomen to be done in patients with culture positive UTI.Results: Among the 200 cases, the prevalence of UTI was higher among females (10%) than males (8%). Among the culture-positive cases UTI, an underlying focus of infection was present in 89% of cases and only 11% of cases did not have any foci. In this study, the % of cases with a duration of fever more than 5 days was 57, as compared to 43% in patients with fever less than 5 days. Among the 19 UTI cases, 5 of them presented with voiding difficulties and all the 5 cases had significant growth on culture. There was a significant association between UTI cases and voiding difficulties.Conclusions: Hence through this study, authors concluded that pyuria of &gt;5 pus cells /HPF in the centrifuged sample should be considered as significant pyuria and hence further evaluation should be done in all these cases to promptly initiate antibiotic treatment and also to prevent morbidity and several long term sequelae.

Clinical profile of pediatric patients with urinary tract infection in a tertiary care centre in Kashmir, India

Background: The urinary tract is a common site of infection in pediatric patients. Author studied the clinical and microbiological profile along with the antibiotic resistance in children with UTI attending centre.Methods: It was a prospective study was conducted in the Department of Pediatrics, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India over a period of one year from August 2017 to August 2018.A total of 250 children aged 1-36 months were included in the study. A proper history and examination were done in each case. A clean catch mid-stream urine sample was obtained from each child. Quantitative microscopy and urine culture were performed. Standard biochemical tests were done to identify the isolates and for determination of antibiotic sensitivity.Results: Out of the 250 children studied , a total of 216 children were diagnosed as UTI by positive urine culture.102 were males and 114 were females. Significant pyuria was detected in 85%patients. Fever with irritability was the most common presenting symptom (71%) followed by vomiting (63%) and abdominal pain (52%).The most common uropathogen detected was E. coli (57%) followed by Klebsiella spp. (20%), proteus (16%), pseudomonas (5%), and candida (2%). Majority of the patients responded to treatment with ceftriaxone followed by cefixime. Antibiotic resistance in vitro was least seen with amikacin (25%) followed by nitrofurantoin (11%). 91.3% of UTI detected was nosocomial. Vesicoureteral reflux was found in 49% of patients while 13% were diagnosed with posterior urethral valve.Conclusions: Urinary tract infection should be considered as one of the most important differential diagnosis in patients with fever attending pediatric OPD. Urine microscopy and culture should be a part of routine diagnostic evaluation in all febrile children. Early treatment of UTI is important to prevent later sequelae including pyelonephritis and renal scarring.

New Insights in Treatment Options in Pediatric Urinary Tract Infection

Abstract Urinary tract infection (UTI) represents one of the most frequent infections with bacterial etiology during childhood. In infants and toddlers with fever without source UTI’ investigation should be carried out, since signs and symptoms are nonspecific. However, obtaining uncontaminated urine samples from these patients can be challenging and time consuming; all current collection methods (clean-catch, plastic collection bag, catheterization, etc) have disadvantages. Criteria for UTI definition are represented by the presence of significant number of a single uropathogen, this number being different depending on the collection method: at least 1000 colony-forming unit (CFU/ml) for catheter samples and at least 100.000 CFU/ml from midstream clean-catch samples or 50.000 CFU/ml and significant pyuria in a symptomatic or febrile child. Accurate diagnosis of UTI is essential to avoid any antibiotic overuse and expensive investigations. UTI caused by resistant bacterial strains has an increasing prevalence in children. In pediatric population, extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) represent the etiology of around 15% of UTIs. Because of limited therapeutic options the reintroduction of some old antimicrobial agents is necessary, therefore Nitrofurantoin and Fosfomycin, can represent alternatives for oral treatment and prophylaxis of UTIs in children or in case of resistance suspicion to other drug classes. It is important to recognize patients at risk, such as children with recurrent UTIs, kidney abnormalities, like vesicoureteral reflux and previous antibiotherapy, in order to recommend adequate empiric treatment, especially against resistant bacteria.

Incidence of urinary tract infection in febrile children

Background: Urinary tract infection is diagnosed by the growth of many organisms of a single specimen in the urine with presence of many symptoms. bacteriuria is defined as growth with a colony of &gt;105/ml of a single species in a midstream clean catch urine sample.Methods: A cross sectional study was undertaken in febrile children with urinary tract infection attending Department of Paediatrics, tertiary care hospital, Bangalore during the period January 2017 to December 2017.Results: Out of the 200 children studied, 93 children belonged to the age group of 6 year to 12 year and 57 children belong to 1 year to 6-year age group and 50 children belongs to 12 year to 18-year age group. 97 children showed significant pyuria in centrifuged urine sample of which 49 were males and 48 were females. Majority 45 children were belonging to age group of 6 year to 12 year. Out of 97 children showed significant pyuria in centrifuged urine sample of which 46 children 5-10 cells/HPF and 27 children showed &gt; 10 cells/HPF and 24 cases showed &lt; 5cells / HPF. Out of 200 children, in 29 cases urine culture showed E. coli growth and 51 cases showed no growth.Conclusions: Urinary tract infections are common in childhood. Nearly all UTIs are caused by bacteria that enter the opening of the urethra and move upward to the urinary bladder and sometimes the kidneys.

1514. Clinical Decision Making in Suspected Urinary Tract Infection in Hospitalized Patients: Which Factors Lead to Treatment, and How Would Reflex Urine Cultures Impact Diagnosis?

BackgroundWhile urinary tract infections (UTIs) are frequently encountered in clinical practice, the clinical decision-making involved in the diagnosis of hospital-acquired UTIs is not well described in the literature. The purpose of our study was to identify the clinical data most commonly used to diagnose hospitalized patients with UTI and to investigate the potential impact that a reflex urine culture model (whereby urine cultures are only performed if a specific urinalysis [UA] or microscopy threshold is reached) could have on diagnosis.MethodsWe performed a retrospective chart review of adult patients admitted to an urban university hospital with positive urine cultures >48 hours after admission between January 1, 2015 and February 28, 2015. Patient demographics, clinical symptoms, urine studies, and adverse effects were collected. We then applied a reflex urine culture model to our data using two thresholds: (1) any abnormality in leukocyte esterase, nitrite, blood, or protein on UA, and (2) urine microscopy with >10 white blood cells per high-power field (WBC/hpf).ResultsIn total, 258 patients with positive urine culture were reviewed. Eighty patients were treated for UTI. The strongest predictors of treatment were the presence of >100k colony-forming units (CFUs) in culture (OR 7.55, P = 0.0001) and an abnormal UA (OR 5.40, P = 0.002). Seven-treated patients (9%) experienced an adverse reaction. Applying the reflex culture model requiring abnormal UA, 9% of treated patients would not have been cultured. Moving the threshold to >10 WBC/hpf, the number rose to 41%.ConclusionAt our institution, clinicians relied on high colony counts and abnormal urinalyses to guide UTI treatment in hospitalized patients. Though pyuria alone is not diagnostic of a UTI, it can be supportive, and a large proportion of treated patients did not have significant pyuria. These findings highlight areas for clinician education. Additionally, our study suggests reflex urine cultures in the hospital setting may reduce the number of urine cultures performed on samples with lower likelihood of true infection. This in turn could improve diagnostic accuracy and decrease laboratory costs, antibiotic usage, and adverse effects, making it a potentially useful antimicrobial stewardship tool.Disclosures All authors: No reported disclosures.

Catheter Associated Urinary Tract Infection: Prevalence, Microbiological Profile and Antibiogram at a Tertiary Care Hospital

Background: Catheter associated Urinary tract infections (CAUTI) are the most common nosocomial infection. Though urinary tract catheterization is an important aspect of medical care, its inappropriate use may lead to significant morbidity and mortality, increased hospitalization and financial burden. This study was carried out to identify the etiological agents of UTI and its antibiogram among inpatients with indwelling catheters.Methods: A total of 136 urine samples were collected over a period of 10 months. Microscopic and macroscopic examinations were performed. Isolation, identification and antimicrobial susceptibility testing was performed by standard microbiological methods. Statistical analysis of data was done by chi-square test.Results: Out of the 136 patients, 17 (12.5%) developed catheter-associated UTI. Development of significant bacteriuria was not affected by sex, age, urine pH or antibiotic intake however there was significant association be-tween significant pyuria and significant bacteriuria (p&lt;0.001). E coli accounted for 35.3% followed by Klebsiella spp and Enterococcus spp. Cotrimoxazole was the most effective amongst antibiotics tested followed by Nitrofurantoin . Gram negative bacteria were least sensitive to Ampicillin.Conclusion: This study suggests urine culture and sensitivity should be done among the catheterized patients on regular basis. Unnecessary urethral catheterization should be avoided to reduce catheter-related complications.

Relation between Pyuria and Bacteriuria in Urinary Tract Infection

Introduction: As urinary tract infections are very common in all age groups and its prevalence is increasing due to various factors like poor hygiene, increasing prevalence of diabetes and injudicious use of antimicrobials. Some patients have significant pyuria with bacteriuria, some have only pyuria without bacteriuria, while some have bacteriuria without pyuria. This study was conducted to find relationship between pyuria and bacteriuria in patients with urinary tract infections. Materials and methods: Urine samples from 100 patients were taken out of which 71 were females and 29 were males. Routine microscopy of urine samples was done and WBC count of more than 5/HPF was taken significant. Urine samples were processed according to guidelines and cultured on Hichrome UTI agar,Macconkey agar and Blood agar which was incubated at 370C. The organisms which growed on them were biochemically confirmed. Results: Out of 100 urine samples 40 showed significant pyuria and 60 showed insignificant pyuria. 21 were culture positive with significant pyuria and 19 were culture negative.