Bacteria and leukocyte in urine? help in diagnosing



Criteria for interpretations :- 1 ) Sample should be freshly voided clean catch mid stream urine sample following SOP of collection both in males and females. 2 ) Sample should be submitted immediately to the Lab for processing, if delay > 2 hours, sample should be kept in refrigerator 2 - 8 degree Celsius to prevent multiplications of bacteria. Results :- I). Uncentrifuged urine for Gram's stain (GS) :- Seeing one or more organisms in the uncentrifuged GS urine under oil immersion (1000 X) correlates with significant bacteriuria. More importantly, it helps in guiding choice of empiric antimicrobial agents at the time of initial clinical evaluation based on GS observation and morphology. However, Clinician should consider local sensitivity patterns of the possible pathogen. Exception :- Staphylococcus aureus. II). Leucocytes / Pus cells :- Ordinarily, presence of ≥10 pus cells/HPF in centrifuged urine and ≥5 pus cells in uncentrifuged urine is considered significant. Some authors consider counts as low as 2-5 WBCs /HPF important in a centrifuged specimen in the female with appropriate symptoms. Some studies show that a combination of significant pyuria (≥ 10 pus cells/mm3 ) and significant bacteriuria (≥ 3 bacteria/HPF) detected by Gram-stained smear can increase the sensitivity and NPV to 100% when used in parallel combination, considering the test as positive if any of the two criteria was positive. In this manner the combination of two criteria is useful in screening, a point that was stressed in other literatures. On the other hand using the two criteria in serial, i.e. considering the test as positive only if both criteria were positive can increase the specificity to 100% and PPV to 100% in diagnosis of UTI in asymptomatic female children. Similar conclusions were raised by other workers also. . It can be concluded from this study that pyuria at cut-off value of 10 pus cells/mm3 and bacteriuria (detected by Gram-stain) at cut-off value of 3/HPF are highly specific resulting in a high PPV (>90%) for each tests. It is recommended to use both criteria in parallel combination as a screening tool for asymptomatic UTI since their joint sensitivity is 100% in addition to being cheep and easy to perform. Please note :- 1) Bacteria in the urine, especially gram-negative rods, usually indicate a urinary tract infection (either cystitis or pyelonephritis), although bacteriuria can also occur in prostatitis. Escherichia coli is the most common bacterium isolated from urine samples. 2 ) Pyuria indicates the presence of pus (white blood cells; leukocytes) in the urine, which may or may not be caused by urinary tract infection. 3 ) Typically, the presence of a single type of bacteria growing at high colony counts is considered a positive urine culture. For clean catch samples that have been properly collected, cultures with greater than 100,000 colony forming units (CFU)/mL of one type of bacteria usually indicate infection.

All these findings should be correlated with the total clinical and other investigative profile of the patient, to initiate proper antibiotic therapy.

Acute urinary tract infection.... Pyelonephritis, cystitis, urethritis are among differential diagnosis...

Clinical correlation needed

UTI - advice to send clean-catched midstream urine for culture and sensitivity and treat according to culture report.

Acute urinary tract infection

Plenty of pus cells....acute UTI

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