The Relationship Between Pyuria and Infection in Patients With Indwelling Urinary Catheters
A Prospective Study of 761 Patients
Paul A. Tambyah, MBBS;
Dennis G. Maki, MD
Arch Intern Med. 2000;160:673-677.
Background Pyuria is universally considered as essential for identifying urinary tract infections in noncatheterized patients. The utility of pyuria in the catheterized patient, to identify catheter-associated urinary tract infection (CAUTI), has not been adequately defined.
Methods We prospectively studied 761 newly catheterized patients in a university hospital; 82 (10.8%) developed nosocomial CAUTI (>103 colony-forming units per milliliter). While catheterized, each patient was seen daily, a quantitative urine culture was obtained, and the urine white blood cell concentration was measured quantitatively using a hemocytometer.
Results The mean urine leukocyte count in patients with CAUTI was significantly higher than in patients without infections (71 vs 4 per microliter; P=.006). Pyuria was most strongly associated with CAUTI caused by gram-negative bacilli (white blood cell count, 121 vs 4 per microliter; P=.03); infection with coagulase-negative staphylococci and enterococci (white blood cell count, 39 vs 4 per microliter; P=.25) or yeasts (white blood cell count, 25 vs 4 per microliter; P=.15) produced much less pyuria. Pyuria with a white blood cell count greater than 10 per microliter (>5 per high-power field in a conventional urinalysis) had a specificity of 90% for predicting CAUTI with greater than 105 colony-forming units per milliliter but a sensitivity of only 37%.
Conclusions In patients with short-term indwelling urinary catheters, pyuria is less strongly correlated with CAUTI than in noncatheterized patients with urinary tract infection. The strongest association is with CAUTI caused by gram-negative bacilli; the association is far weaker for infections caused by gram-positive cocci or yeasts. Most patients with CAUTI are asymptomatic and do not have associated fever. Pyuria should not be used as the sole criterion to obtain a urine culture in a patient with a catheter.
From the Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison.
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