Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605006, India.
Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Reserach, Dhanvantri Nagar, Puducherry, 605006, India.
F1000Res. 2024 May 22;13:291. doi: 10.12688/f1000research.144853.2. eCollection 2024.
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 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.
尿液显微镜检查用于检测脓细胞，是住院普通内科患者常规护理的常见检查之一。一些先前的研究表明，在该人群中无菌性脓尿并不少见。我们研究了住院非尿路感染（UTI）诊断患者中脓尿的患病率。我们排除了无症状菌尿（ASB）患者。使用室计数法对未离心尿液中的脓尿进行定量，≥ 10 个脓细胞/ mm 被认为有意义。我们还将这种方法与常用但不太准确的离心尿液（常规方法）中脓细胞/高倍视野计数法进行了比较。我们研究了 196 例患者；113 例（57.7%）为男性。大多数（175 例[89.3%]）患者因感染住院。我们发现，研究组 18.4%的患者有无菌性脓尿，且与同时存在的显微镜血尿密切相关（未经调整的优势比，3.74[1.65 至 8.50]；P=0.002）。我们没有发现脓尿与女性、糖尿病、急性肾损伤或当前使用抗生素之间存在关联。通过常规方法，56 例（28.6%）患者有显著的脓尿。与室计数法相比，常规法的灵敏度为 69.4%（63-75.8%），特异性为 80.6%（75.1-86.2%）。阳性预测值和阴性预测值分别为 44.6%（37.7-51.6%）和 92.1%（88.4-95.9%）。我们得出结论，无菌性脓尿和显微镜血尿可能存在于一部分无 UTI 或 ASB 的住院普通内科患者中。在解释异常尿液分析报告的意义时，临床判断至关重要。
