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[Postoperative pyuria after TUR-P: the study of postoperative pyuria by using NFLX].

The postoperative duration of pyuria was studied in 35 patients who underwent transurethral resection of the prostate (TUR-P). The average postoperative duration of pyuria was 58.0 +/- 23.6 days. The age over 70 years, preoperative indwelling of urethral catheter and the preoperative urinary tract infection did not make the duration of pyuria longer. The volume of resected prostatic tissue over 20 g and the existence of diabetes mellitus make it significantly longer. It is effective and safe to use a low-dose antibacterial agent such as NFLX which has a broad spectrum and hardly develops bacterial resistance after TUR-P. It is suggested unnecessary to change the anti-bacterial agent even when pyuria continues.

Aged

Detection of bacteriuria and pyuria by URISCREEN a rapid enzymatic screening test.

A multicenter study was performed to evaluate the ability of the URISCREEN (Analytab Products, Plainview, N.Y.), a 2-min catalase tube test, to detect bacteriuria and pyuria. This test was compared with the Chemstrip LN (BioDynamics, Division of Boehringer Mannheim Diagnostics, Indianapolis, Ind.), a 2-min enzyme dipstick test; a semiquantitative plate culture method was used as the reference test for bacteriuria, and the Gram stain or a quantitative chamber count method was used as the reference test for pyuria. Each test was evaluated for its ability to detect probable pathogens at greater than or equal to 10(2) CFU/ml and/or greater than or equal to 1 leukocyte per oil immersion field, as determined by the Gram stain method, or greater than 10 leukocytes per microliter, as determined by the quantitative count method. A total of 1,500 urine specimens were included in this evaluation. There were 298 specimens with greater than or equal 10(2) CFU/ml and 451 specimens with pyuria. Of the 298 specimens with probable pathogens isolated at various colony counts, 219 specimens had colony counts of greater than or equal to 10(5) CFU/ml, 51 specimens had between 10(4) and 10(5) CFU/ml, and 28 specimens had between 10(2) and less than 10(4) CFU/ml. Both the URISCREEN and the Chemstrip LN detected 93% (204 of 219) of the specimens with probable pathogens at greater than or equal to 10(5) CFU/ml. For the specimens with probable pathogens at greater than or equal to 10(2) CFU/ml, the sensitivities of the URISCREEN and the Chemstrip LN were 86% (256 of 298) and 81% (241 of 298), respectively. Of the 451 specimens with pyuria, the URISCREEN detected 88% (398 of 451) and Chemstrip LN detected 78% (350 if 451). There were 204 specimens with both greater than or equal to 10(2) CFU/ml and pyuria; the sensitivities of both methods were 95% (193 of 204) for these specimens. Overall, there were 545 specimens with probable pathogens at greater than or equal to 10(2) CFU/ml and/or pyuria. The URISCREEN detected 85% (461 of 545), and the Chemstrip LN detected 73% (398 of 545). A majority (76%) of the false-negative results obtained with either method were for specimens without leukocytes in the urine. There were 955 specimens with no probable pathogens or leukocytes. Of these, 28% (270 of 955) were found positive by the URISCREEN and 13% (122 of 955) were found positive by the Chemstrip LN. A majority of the false-positive results were probably due, in part, to the detection of enzymes present in both bacterial and somatic cells by each of the test systems. Overall, the URISCREEN is rapid, manual, easy-to-perform enzymatic test that yields findings similar to those yielded by the Chemstrip LN for specimens with both greater than or equal to 10(2) CFU/ml and pyuria or for specimens with greater than or equal to 10(5) CFU/ml and with or without pyuria. However, when the data were analyzed for either probable pathogens at less 10(5) CFU/ml or pyuria, the sensitivity of the URISCREEN was higher (P less than 0.05).

Bacteriological Techniques

Significance of pyuria in urinary sediment.

Microscopic examination of the urinary sediment to determine the degree of pyuria is an accepted method to screen for urinary tract infection. We investigated the significance of pyuria in relation to the method of specimen acquistion, number of white blood cells and isolation of pathogens on culture. Only 36 per cent of our patients with more than 10 white blood cells per high power field on examination of the first random specimen had more than 10 white blood cells per high power field when a repeat clean catch midstream specimen was examined, and only 20 per cent of the patients had more than 10(5) pathogens per ml. on culture. However, the finding of more than 10 white blood cells per high power field on a clean catch mid stream specimen indicated more than 10(5) pathogens per ml. in 40 per cent of the cases. The use of a higher threshold for significant pyuria (more than 20 white blood cells per high power field) on examination of a random specimen increased the incidence of more than 10(5) bacteriuria found in specimens with initial pyuria by 43 per cent and represents the additional detection of 8.7 per cent of the total poputation studied. These data indicate that when screening for pyuria and infection one should either obtain a clean catch midstream specimen for examination of urinary sediment or increase the threshold for significant pyuria on a random specimen.

Adult

Pyuria: index of infection in patients with spinal cord injuries.

Little is known about the significance of pyuria in patients with spinal cord injuries. The progress in hospital of 55 such patients was studied. They were divided into 2 groups according to the method of bladder drainage on admission. Group A comprised 43 patients with indwelling catheters. Group B comprised 12 patients who were able to void with tapping, with/without compression and on intermittent catheterisation. The results showed that group A had a mean pyuria level of 185 WBC/HPF on admission. The incidence of urinary tract infection was 4 per patient during hospitalisation and the mean duration of bladder training was 82 days. Group B had a mean pyuria level of 32 WBC/HPF on admission. The incidence of urinary tract infection was 1 per patient during hospitalisation and the mean duration of bladder training was 40 days. The difference between groups A and B for all 3 parameters was statistically significant. These results suggest that patients with spinal cord injuries and indwelling catheters have a higher pyuria level and an increased risk of significant morbidity secondary to urinary tract infection, especially at the pyuria level of 100 WBC/HPF. A low pyuria level of less than or equal to 30 WBC/HPF was associated with a nil or low incidence of bacteriuria and urinary tract infection in our patients.

Adult

[Clinical studies of bacteriuria in renal transplantation recipients. Correlation with pyuria and symptomatic genitourinary tract infection].

The clinical state of bacteriuria and its correlation with pyuria and symptomatic genitourinary tract infection (GUTI) were studied in 42 renal transplantation recipients who were followed up in the Kidney Center of Tokyo Women's Medical College over 6 months and who showed bacteriuria more than 3 times between January and December in 1987. The results were as follows. 1) Of the 42 recipients, bacteriuria was found less than 5 times in 19 patients, 6 to 10 times in 18 patients and more than 11 times in 5 patients. There was a tendency for the same bacteria to be isolated several times from the same patient. The most commonly isolated bacterias were Enterobacter, Enterococcus, Serratia and E. coli. 2) Bacteriuria was accompanied by pyuria in 33 patients (79%) and by symptomatic GUTI in 12 patients (29%). Bacteriuria without pyuria was shown in 9 patients (21%) without symptomatic GUTI and it was suggested that bacteriuria did not result in graft hypofunction after two years. 3) Of 16 patients with bacteriuria accompanied by pyuria, symptomatic GUTI occurred in 9 patients (56%). Of these, one patient was found to have VUR of the transplanted kidney, another was found to have VUR of the native kidney, and a third patient died due to interstitial pneumonitis presumably as a result of overimmunosuppression. Transplantation recipients with bacteriuria accompanied by pyuria develop symptomatic GUTIs frequently and should be treated with proper antibacterial agents. When bacteriuria continues, further examination should be performed for an organic disease of the urinary tract or an overimmunosuppressed state. When a patient shows bacteriuria without pyuria, chemotherapy is not needed and it is sufficient to observe the course carefully.

Adult

Fever, bacteriuria, and pyuria in spinal cord injured patients with indwelling urethral catheters.

Little is known about the significance of pyuria in spinal cord injury patients with indwelling urethral catheters (IUCs). The hospital courses of 32 such patients admitted to a rehabilitation hospital from January 1986 to December 1987 were reviewed to determine the incidence of unexplained febrile episodes, ie, no obvious nonurinary source of infection. All patients had positive admission urine cultures (greater than 100,000 colony-forming units/mL). Patients were divided into two groups based on the level of pyuria in admission urinalyses. Group A (the low pyuria group) was composed of 22 patients with less than or equal to 50 white blood cells per high-power field (WBC/HPF). Group B (the high pyuria group) was composed of ten patients with less than 50 WBC/HPF. None were admitted to the rehabilitation program taking antibiotics; none were prophylactically treated for urinary tract infection. The difference in incidence of fever between febrile episodes. Group B had an incidence of 6/10 (60%) febrile episodes. The difference in incidence of fever between the groups was statistically significant (chi2 = 7.31, p less than .01). These results suggest that SCI patients with IUCs and gross pyuria may be at risk for increased morbidity secondary untreated urinary tract infection.

Adolescent

The usefulness of screening tests for pyuria in combination with culture in the diagnosis of urinary tract infection.

A prospective study was conducted to examine the usefulness of screening tests for pyuria in combination with culture in the diagnosis of urinary tract infection (UTI) in outpatients. Midstream urine specimens were collected from 340 patients seen in the emergency treatment center (ETC) and were examined for pyuria using the chamber count method and the Leukocyte Esterase Dipstick test (LE; Bio Dynamics, Indianapolis, IN). All specimens were cultured quantitatively using both 0.01 ml and 0.001 ml calibrated bacteriologic loops. A total of 100 UTIs, defined by combined clinical and laboratory critera, were identified. Sixty-four (64%) infections were identified by culture using the standard interpretive breakpoint of greater than or equal to 10(5) CFU/ml and an additional 36 (36%) were detected using the low-count interpretive breakpoint of greater than or equal to 10(3) CFU/ml. We found pyuria detection by either the chamber count method or the LE test to be extremely useful in directing subsequent culture efforts. By using either of the tests for pyuria to determine the significance of low-count bacteriuria (10(3) - less than 10(5) CFU/ml) we were able to achieve maximum sensitivity (92%-99%) and specificity (99.2-99.6%) for the diagnosis of UTI while minimizing the number of specimens in which low numbers of organisms must be evaluated.

Adolescent

[Evaluation of diagnostic parameters in chronic recurrent urinary tract infection in children. III. Pyuria, hematuria, and proteinuria (author's transl)].

Pyuria, proteinuria and haematuria have been shown to be unreliable parameters for the diagnosis of bacteriuria in 171 children with 455 recurrences of chronic urinary tract infection. Bacteriuria caused haematuria in 5%, proteinuria in 18% and even pyuria in only 47% of all instances. Pyuria has been also found in 11% of sterile urines. The incidence of pyuria increases with the age of the children and depends on the type of the organisms, but the latter was true mainly in children with obstructive lesions of the urinary tract. Children with repeated proteinuria during follow-up tend to have a higher incidence of pathologic findings on the i.v.-pyelogram.

Age Factors

A comparative study of pyuria and asymptomatic bacteriuria in school children.

Urine samples were collected from 1,000 school children aged between 4 and 15 years. Twenty-eight children had significant bacteriuria, while 32 had significant pyuria. Seventeen pupils had both significant bacteriuria and pyuria. The study shows that although there is a positive association between pyuria and bacteriuria, the absence of pus cells in urine samples cannot be taken as evidence of absence of bacteriuria, nor can the presence of pyuria alone be considered as an indication of infection. Escherichia coli is the commonest agent in school children with significant bacteriuria.

Adolescent

[The course of pyuria after transurethral resection of the prostate and factor analysis of its duration].

The course of pyuria and bacteriuria was reviewed in 54 patients undergoing transurethral resection of prostate. Pyuria, which was seen in all cases, lasted for 70.1 +/- 24.7 days and bacteriuria defined as more than 10(4)/ml occurred in 16 patients (30%) postoperatively. To analyze the factors affecting the duration of pyuria, we utilized Hayashi's multidimensional quantification I theory. The factors included age, serum protein, preoperative indwelling catheter, preoperative urinary tract infection, resected weight, postoperative infection, the duration of postoperative indwelling catheter, and the way of antibacterial prophylaxis. The most important factor was resected weight (range 42.8 days), the second was postoperative infection (range 23.9 days) and the third preoperative infection (range 20.9 days). The other factors had no significance. Our analysis showed good correlation between the observed and predicted duration of pyuria (r = 0.82, p less than 0.005).

Aged

Pyuria: its relationship to bacteriuria in spinal cord injured patients on intermittent catheterization.

Observations made during a study of intermittently catheterized spinal cord injured patients suggested that leukocyte counts yield higher results in aliquots of terminal-catheter urine (TCU) than in midstream-catheter urine (MCU) or suprapubic aspirate (SPA). The purpose of this study was to confirm that observation, to examine the relationship of leukocyte counts in TCU, MCU, and SPA to the leukocyte excretion rate (LER), and of pyuria to bacteriuria in this population. We collected sets of urine specimens obtained by SPA and intermittent catheterization (for leukocyte counts and quantitative culture) and timed urine collections (for LER determination). Fifty-two patients were studied for an average of five days. Leukocyte counts were performed in 241 SPA, 250 MCU, and 236 TCU specimens, and LER in 131 timed collections. The mean of the logarithm of leukocyte counts differed significantly between TCU and both MCU and SPA (p less than .0001). The difference between TCU and MCU was greater than 150 leukocytes/mm3 for 25% of paired specimens (mean 624 leukocytes/mm3, median 15 leukocytes/mm3). The statistical correlation between LER and leukocyte counts in all catheter specimens was significant; however, SPA and MCU frequently underestimated LER and TCU overestimated LER. Estimates of pyuria do not clearly separate bacteriuric from abacteriuric specimens. In spinal cord injured patients on intermittent catheterization, aliquots of catheter urine are not suitable for estimation of pyuria, and estimation of pyuria is not a feasible screening test for bacteriuria.

Bacteriuria

Presence of platelet-activating factor in pyuria in humans.

The relationship between the occurrence of platelet-activating factor (PAF) and neutrophils in urine from patients with urinary tract infection was examined. PAF was detected in human pyuria, when leukocyte levels reached at least 300 cells/microL (n = 45), but not in normal urine (n = 12). The amount of PAF found in pyuria, measured by platelet aggregation assay, was 0.01 to 13.3 pmol/mL. A close correlation was seen between the amount of PAF present and the number of urinary leukocytes (p less than 0.01, r = 0.70). The leukocytes in pyuria consisted almost entirely of neutrophils (96 +/- 4%, mean +/- S.D.). Our findings suggest that the occurrence of PAF is associated with the accumulation of neutrophils in urine.

Animals

[Multifactorial analysis of the pyuria after transurethral prostatectomy].

Multifactorial analysis on 395 patients revealed important factors which prolong the pyuria after transurethral prostatectomy. They were the age of the patient, anemia and leukocytosis before surgery. These are factors which relate with the defense mechanism of the patient. Local factors, such as the duration of indwelling urethral catheter, the size of the prostate or prostatic bed and preoperative infection, were not so important for prolonging the pyuria after transurethral prostatectomy. The time of the resection and weight of the prostate had an intimate relation each other, and the former was the more important factor. The use of antimicrobials probably controlled these local risk factors, thus making them unimportant in the prolongation of the pyuria after transurethral prostatectomy.

Age Factors

[The analysis of prognostic factors on postsurgical pyuria of benign prostatic hypertrophy].

The outcome of postsurgical pyuria in benign prostatic hypertrophy was studied in 87 patients, and the factors that might affect the outcome were determined. No significant differences were found between operation method and duration until normalization of pyuria, which was 75.5 +/- 46.0 days for transurethral resection of the prostate, 72.7 +/- 30.6 days for suprapubic prostatectomy and 69.3 +/- 32.7 days for retropubic prostatectomy. Prognostic factors were statistically analyzed preoperatively, at operation, and postoperatively. The definite prognostic factors were preoperative diabetes mellitus, preoperative pyuria, preoperative bacteriuria, and postoperative hypoproteinemia. The probable prognostic factors were old-age, preoperative indwelling catheters, heavy prostate tissue, postoperative bacteriuria, postoperative anemia and postoperative complications.

Aged

Detection of pyuria and bacteriuria in symptomatic ambulatory women.

OBJECTIVE: To compare the abilities of two methods for rapid detection of pyuria and three methods of urinalysis to predict significant bacteriuria in symptomatic ambulatory women. DESIGN: Prospective simultaneous comparison of the results of dipstick urinalysis, standard microscopic urinalysis, and hemocytometric cell counting and Gram staining with the results of a standard urine culture. SETTING: Two outpatient ambulatory care facilities serving predominantly minority and uninsured individuals. SELECTION CRITERIA: Nonpregnant women presenting with symptoms of urinary tract infection without symptoms of vaginal infection. MEASUREMENTS AND MAIN RESULTS: 105 women with symptoms were evaluated. The sensitivities of the dipstick urinalysis and the microscopic urinalysis in predicting pyuria as defined by hemocytometry were 0.76 and 0.77, respectively, and their specificities were 0.94 and 0.97, respectively. The sensitivities and specificities of the three methods of urinalysis in predicting greater than or equal to 10(4) colony-forming units (CFU)/mm3 in a urine culture were 0.88 and 0.70 for the leukocyte esterase-nitrite dipstick urinalysis, 0.98 and 0.68 for the standard microscopic urinalysis, and 1.00 and 0.49 for the Gram staining and hemocytometric cell counting. CONCLUSIONS: The standard urinalysis was the most accurate single method to predict significant bacteriuria in symptomatic ambulatory women. Sequencing the dipstick urinalysis with the standard urinalysis may be a cost-effective approach to evaluating these patients in clinical practice.

Adolescent

Significance of immediate preoperative bacteriuria with pyuria in renal transplant recipients.

The presence of bacteriuria and pyuria on urinalysis immediately before renal transplantation has resulted in cancellation of surgery because of concern about post-transplant wound infection. Of 113 renal transplant recipients reviewed 41 (36 per cent) had 5 or more white blood cells per high power field with bacteria in either a voided urine or bladder washout specimen obtained just before grafting. Of those 41 patients 2 suffered postoperative wound infections. Of 72 patients (64 per cent) with less than 5 white blood cells or no bacteria on a preoperative specimen 1 suffered a wound infection (p not significant by Fisher's exact test). Preoperative urine cultures and operative bladder cultures of all 3 patients failed to yield the organisms found later in the wound infections. The factors of sex, insulin-dependent diabetes, delayed graft function, living related versus cadaver donor and pre-transplant splenectomy had no significant relationship to wound infection rates. Renal transplantation can be performed safely in patients who have pyuria and bacteriuria but no signs or symptoms of infection.

Adult

Pyuria: its predictive value of asymptomatic bacteriuria in ambulatory elderly men.

A total of 664 urine samples collected from 254 asymptomatic, ambulatory, elderly men was examined for pyuria with a standardized glass slide microscopy method. The presence or absence of more than 10 polymorphonuclear leukocytes per high power field was highly predictive of the presence or absence of significant bacteriuria, respectively. The determination of pyuria in this select population may be a useful and inexpensive test to screen for bacteriuria.

Aged

Detection of bacteriuria and pyuria within two minutes.

A study was performed to evaluate two rapid urine screening methods, Bac-T-Screen (Marion Laboratories, Inc., Kansas City, Mo.) and Chemstrip LN (Boehringer Mannheim Diagnostics, BioDynamics, Indianapolis, Ind.), for their ability to screen for bacteriuria and pyuria within 2 min. A total of 1,000 urine specimens were tested with the Bac-T-Screen and the Chemstrip LN and compared with a semiquantitative plate culture method. Of the 1,000 specimens tested, 249 had colony counts of greater than or equal to 10(5) CFU/ml by the culture method. Of these, the Bac-T-Screen detected 94.8% (236 of 249) and the Chemstrip LN detected 84.7% (210 of 249). There were 120 pure cultures of probable pathogens of which the Bac-T-Screen detected 97.5% (117 of 120) and the Chemstrip LN detected 91.7% (110 of 120). Leukocyte counts were performed on all specimens, and both methods have the ability to detect greater than 10 leukocytes per mm3 in a majority (greater than 93%) of the specimens. The cost per test for a negative screen is approximately $1.30 for the Bac-T-Screen and $0.40 for the Chemstrip LN. Overall there is a similar negative predictive value with both methods for bacteriuria and pyuria.

Bacteriological Techniques