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5 Cards in this Set
- Front
- Back
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Pyuria - what is a 'significant' count of polymorphs e.g. one which indicates likely UTI per mL of urine?
What can cause STERILE pyuria (e.g. significant count and no bacterial growth)? |
10,000 per mL. 96% of symptomatic patients with significant bacteriuria (e.g. with UTI) have at least this no of WCC, and <1% of asymptomatic people WITHOUT bacteriuria (e.g. without UTI) have this no of WCC.
STERILE pyuria (think hidden/unusual infections, inflammation, Ca) - nonspecific urethritis males, prostatitis, renal tract neoplasm, renal calculi, catheterisation, renal TB, ANTIBIOTIC TREATMENT |
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Haematuria - significance in diagnosing UTI? Proteinuria?
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Nonspecific findings
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Who DOESN'T need urinary cultures? Who DOES need them?
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Premenopausal (young), sexually active women with uncomplicated UTI.
Needed in recurrent infection, complicated UTI, men, elderly, or where cause infection not clinically evident |
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a) What is the usual bacterial count considered likely in symptomatic patients to indicate UTI?
b) In which pt group do we accept lower counts as likely to indicate infection? c) what is the significance of a count such as that in a) in an asymptomatic woman? d) what about a count LOWER than a), but in a symptomatic woman? |
a) >10^5/mL - 95% likely
b) men - 10^3/mL still suggests infection c) only 80% chance UTI - repeat and if still >10^5 and same organism then 95% likely UTI d) depends on WCC - if significant pyuria >10,000 WCC per mL then may be bacterial UTI with low bacterial numbers or urethritis (c.trachomatis, n. gonorrhoea). If no pyruria and negative culture - ?may have ureaplasma infection |
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Are blood cultures needed in UTI?
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Not usually - don't alter management, unnecessary in majority of cases of uncomplicated pyelonephritis. Consider in
- recent instrumentation - known anatomic abnormality - failure empiric treatment - immunosuppression - significant comorbidity e.g. DM - major sepsis - fever unclear cause |
