ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Current Pyuria Cutoffs Promote Inappropriate Urinary Tract Infection Diagnosis in Older Women.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed, 38 citations in OpenAlex.
- An observational diagnostic accuracy study comparing the urine dipstick with a consensus-based reference standard for the diagnosis of urinary tract infections in older adults.BMC geriatrics · 2026Observational
- Variation in Guidelines for the Management of Acute Uncomplicated Urinary Tract Infections Across the United States, Europe, and Australia.International urogynecology journal · 2026Review
- Antimicrobial resistance in ESKAPEE pathogens isolated from institutionalized vs. non-institutionalized elderly patients with urinary tract infections: a 5-years study.World journal of urology · 2026Observational
- Article
- Whole-genome characterisation of Escherichia coli isolates from older women with urinary tract infection and asymptomatic bacteriuria.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Urine Analysis as a Reliable Indicator of a Urinary Tract Infection: A Cross-Sectional Study.Cureus · 2026Article
- Optimizing Prevention of Recurrent Urinary Tract Infections in Older Patients with Frailty.Drugs & aging · 2025Review
- Article
- Urine flow cytometry in older adults urinary tract infection diagnosis: is it time to reevaluate thresholds for men and women?BMC geriatrics · 2025Article
- The role of urine microbiota in culture-negative patients with pyuria.World journal of urology · 2025Article
- Exploring the association between the degree of pyuria and urinary tract infections.Microbiology spectrum · 2025Article
- Urine Leukocyte Counts for Differentiating Asymptomatic Bacteriuria From Urinary Tract Infection and Predicting Secondary Bacteremia.Journal of Korean medical science · 2025Article
- Prevalence of recurrent urinary tract infections and its associated factors in female staff of reproductive age group in a medical college in central Kerala: a cross-sectional study.BMC infectious diseases · 2025Article
- Article
- Overcoming challenges in the management of recurrent urinary tract infections.Expert review of anti-infective therapy · 2024Review
- The incidence, clinical features and outcome of urinary tract infections in geriatric patients: A prospective longitudinal study.IJID regions · 2024Article
- Performance of Urinalysis Parameters in Predicting Urinary Tract Infection: Does One Size Fit All?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- YELLOW RoUTIne prospective cohort study protocol: insight in the dynamics of bacteria in the elderly bladder.BMC infectious diseases · 2024Observational
- Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department.International journal of emergency medicine · 2024Article
- Reduction of misdiagnosis in urinary tract infections during pregnancy: The role of adjusted urine flow cytometry parameters.PloS one · 2024Article
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Authors and funding
16 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary tract infection (UTI) in older women. The presence of pyuria remains the cornerstone of UTI diagnosis. However, >90% of ASB patients have pyuria, prompting unnecessary treatment. We quantified pyuria by automated microscopy and flowcytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for UTI in older women.
methodsWomen ≥65 years with ≥2 new-onset LUTS and 1 uropathogen ≥104 colony-forming units (CFU)/mL were included in the UTI group. Controls were asymptomatic and classified as ASB (1 uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Patients with an indwelling catheter or antimicrobial pretreatment were excluded. Leukocyte medians were compared and sensitivity-specificity pairs were derived from a receiver operating characteristic curve.
resultsWe included 164 participants. UTI patients had higher median urinary leukocytes compared with control patients (microscopy: 900 vs 26 leukocytes/µL; flowcytometry: 1575 vs 23 leukocytes/µL; P < .001). Area under the curve was 0.93 for both methods. At a cutoff of 264 leukocytes/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leukocytes/µL had a poor specificity (36%) and a sensitivity of 100%.
conclusionsThe degree of pyuria can help to distinguish UTI in older women from ASB and asymptomatic controls with pyuria. Current pyuria cutoffs are too low and promote inappropriate UTI diagnosis in older women. Clinical Trials Registration. International Clinical Trials Registry Platform: NL9477 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL9477).
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