The objective of this study was to determine the incidence, associations, evaluation, and management of
pyuria in patients admitted to the hospital with nonurinary
infections.
METHODS: The study population included 210 patients (66 children; 144 adults). Nearly one-third had ≥5 white blood cells (WBCs) per high-power field (
pyuria).
Pyuria was more common in women (P < .001) and in patients with GYN
infections (P = .001) and less common in patients with
pneumonia (P < .001). Cultures were performed on 18 of 19 children (94.7%) and 26 of 43 adults (60.5%) with
pyuria. Of those, 11.1% of children and 42.1% of adults had a positive culture, and all but one of those met criteria for a
urinary tract infection. Excluding patients with GYN
infections, only 18.8% of patients with
pyuria had a positive culture. Of the 44 patients with
pyuria who were cultured, a positive culture was associated with having a GYN
infection (P = .01), moderate or large amounts of bacteria in the urine (P = .005), and a positive urine
nitrite (P = .004). The absolute number of WBCs or red blood cells in the urine and the presence of casts,
proteinuria, and
leukocyte esterase were not associated with positive culture or
urinary tract infection. Neither
pyuria nor a positive culture was related to temperature, systemic WBC count, or
serum albumin, blood
urea nitrogen, or
creatinine.
CONCLUSIONS: