Some uropathogens more associated with pyuria than others

A new study demonstrated that in children with an apparent urinary tract infection (UTI), the proportion with pyuria varied significantly depending on the uropathogen associated with the infection.

The study was conducted in 1181 children who had symptoms consistent with a UTI diagnosis, paired urinalysis and urine culture results, and a positive culture.

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Pyuria was found in 87% of these children and was absent in 13%. Children infected with Enterococccus or Klebsiella species or with Pseudomonas aeruginosa were 3 to 5 times less likely to have pyuria than children with Escherichia coli. Children with Enterococccus, Klebsiella, or P aeruginosa also were less likely to have a positive leukocyte esterase on dipstick urinalysis. The proportions of children with pyuria were similar in children aged younger than 2 months and in those aged 2 months or older (Shaikh N, et al. Pediatrics. 2016;138[1]:e20160087).

Commentary: The take-home message here is that when you suspect UTI, the urine culture is still the gold standard for diagnosis. Relying entirely on urinalysis may lead you to miss UTI, especially UTI caused by these less common organisms. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.