Pyuria in Institutionalized Elderly Subjects

Abstract

in institutionalized e lderly subjects. Can J Infe ct Dis 199 1;2(4 ):142-146. Two hundred and forty-three wine specimens from 76 elderly institutionalized residents were obtained for urine culture, quantitative leukocyte count and winalysis. Significant bacteriuria was present in 153 specimens (63%), including 33 (22%) with more than one organism. Pyuria (greater than or equal to 10 leukocytes/mm3 ) was present in 214 specimens (88%). including 116 (97%) with single organism bacteriuria, 27 (82%) with multiple organism bacteriuria, and 71 (80%) without significant bacteriuria. The leukocyte esterase test had a positive predictive value of 99% for pyuria but a negative predictive value of only 30%. The quantitative level of pyuria was associated with the level of proteinuria and inversely with pH. A relatively constant level of pyuria tended to persist over months to years in a given individual if bacteriuria persisted. Pyuria is significantly associated with bacteriuria in the institutionalized elderly, but is also common in the nonbacteriuric. The clinical significance of pyuria requires further assessment. (3,5,6), and is highest in the most disabled. In the absence of a chronic indwelling catheter, bacteriuria is associated with relatively low morbidity, and treatment with antibiotics is followed by early recurrence (1,2). It has been suggested, however, that the presence of pyuria in individuals with bacteriuria is an indicator of infection of the urinary tract rather than 'colonization', and that pyuria is an indication for therapy. The validity of treatment decisions based on the presence or absence of pyuria has not been reported.This study was undertaken to determine some of the characteristics of pyuria in a group of institutionalized elderly subjects. The association of pyuria with bacteriuria and other urinary characteristics including pH, protein and glucose measurements, type of infecting organism, and the leukocyte esterase test were examined. Some observations on the natural history of pyuria are also reported, including degree of variability in the same individual over time. PATIENTS AND METHODS Patient population:The population studied included 57 males and 19 females, 32% of the 239 permanent residents of the Deer Lodge Centre, an extended care facility in Winnipeg, Manitoba. The mean age was 80 years (range 50 to 95). All participants had a high level of functional disability. Urine specimens were collected from a convenience sample of residents for a study characterizing some features of asymptomatic bacteriuria in this population. Nursing staff collected specimens from one individual whom they felt had bacteriuria based on a subjective assessment of smell and cloudiness, and from a second individual on the same ward whom they thought did not have infection. Residents with symptomatic bacteriuria characterized by symptoms of dysuria, frequency, urgency, hematuria, acute alteration in continence status, suprapubic discomfort, or signs of epididymo-orchitis or bacteremia, were excluded. Micro...

Pyuria Among Chronically Incontinent but Otherwise Asymptomatic Nursing Home Residents

“…In addition to its high prevalence, we found that pyuria is commonly present in the absence of bacteriuria. Although our prevalence rates of pyuria and bacteriuria differ somewhat from previous studies of institutionalized women 5 and men, 4 in which pyuria was defined quantitatively rather than by standard clinical laboratory techniques, our data do support the conclusions of these studies: pyuria is not predictive of bacteriuria in the nursing home population. This also appears to be true in spinal cord injured patients who are on intermittent catheterization 12 …”

“…Pyuria is often used by clinicians to determine if bacteriuria should be treated, yet few studies have examined the prevalence and meaning of pyuria in the nursing home population. One study in a predominantly male, asymptomatic nursing home population found that 93% of bacteriuric specimens and 59% of sterile specimens had pyuria 4 . Another study, which involved 52 female nursing home residents, found a prevalence of pyuria of 50%; of those with pyuria, 73% had sterile urine, and of those with sterile urine, 43% had pyuria 5 .…”

Urinary Tract Infection in Long-Term-Care Facility Residents

“…Thus, the presence of pyuria does not differentiate asymptomatic from symptomatic infection. In residents with persistent asymptomatic bacteriuria, a high degree of pyuria may persist for many years [9]. Approximately 30% of elderly nursing home residents without bacteriuria have pyuria [2].…”

Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria

“…Cytokines Although ASB is asymptomatic by definition, it is not merely a colonization of bacteria in the urinary tract. ASB can be regarded as an asymptomatic infection, since ASB is associated with leukocyturia, elevated urinary cytokines, and an elevated urinary antibody to uropathogens [20,21]. However, the levels of cytokines/chemokines in the urine of elderly people with regard to ASB and acute cystitis have not yet been fully investigated.…”