Failure of the urinalysis and quantitative urine culture in diagnosing symptomatic urinary tract infections in patients with long-term urinary catheters

Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America

“…The low sensitivity of pyuria for identification of CA-bacteriuria in patients with short-term catheterization contrasts with that in patients catheterized for longer durations [109]. In 177 sequential quantitative cultures and urinalyses from 14 patients with long-term urinary catheters during a 12-month period, bacteriuria and pyuria were common even during asymptomatic periods, and levels of pyuria and bacteriuria did not change substantially during symptomatic episodes [110]. Studies have shown that pyuria is also not helpful in establishing a diagnosis in patients with neurogenic bladders [111,112].…”

Asymptomatic bacteriuria: review and discussion of the IDSA guidelines

“…Individuals with underlying genitourinary abnormalities, including elderly residents of institutions or those with chronic indwelling catheters, consistently have associated pyuria [17]. The degree of pyuria in elderly bacteriuric women corre- [15] 2-11 50 Diabetic women [16] 7-9 70 Elderly: nursing home [17] 5-50 90 Spinal-cord injury patients [18] 50 33-86 Indwelling urethral catheter [19,20] 100 70 lates with localization of infection-the number of leucocytes in the urine is increased with upper UTI [17]. The presence or degree of pyuria has not, however, been shown to have prognostic significance [21][22][23].…”

European and Asian guidelines on management and prevention of catheter-associated urinary tract infections

“…The patient with a longterm indwelling catheter is at high risk of morbidity due to this procedure. Bacteriuria with at least one strain is universal, whilst most patients are infected with two or more strains [30,31] (IIb). The commonest infecting organism is E. coli.…”