Question

2.   Your patient’s pee come back positive for lots of bacteria but no white blood cells and your patient has no symptoms of a UTI what could have caused this? HINT What cell will you look for to confirm your suspicion.

Answer 1

This patient has bacteriuria and no pyuria:

Bacteriuria is defined as:

1. Clean catch specimen with > 10⁵ of more than one bacterial species
2. Catheterized specimen with >10³ of more than one bacterial species

Pyuria is defined as:

• Increase in the number of polymorphonuclear cells > 10 White blood cell / high power field.

Therefore the presence of polymorphonuclear cells will suggest urinary tract infection.

Plus the presence of squamous cells indicates contamination: >20 squamous cells / high power field.

The absence symptoms of urinary tract infection, the presence of bacteriuria and the presence of squamous cells in the sample suggest that the sample is contaminated and a fresh sample should be collected

The absence of pyuria indicates the absence of inflammation. Whereas the presence of pyuria indicates urinary tract infection and inflammation.

The presence of bacteriuria in the absence of pyuria should not be treated.

When the patient has no symptoms of urinary tract infection but has the presence of bacteriuria it is called asymptomatic bacteriuria.

Asymptomatic bacteriuria should be treated only in the following situations:

• Pregnant mothers - due to the risk of pyelonephritis, premature delivery, and low birth weight
• Patients undergoing transurethral resection of the prostate - due to the risk of mucosal bleed, sepsis, and bacteremia.

Treating asymptomatic bacteriuria in conditions, other than those mentioned above, leads to

1. Increased risk of antibiotic resistance.
2. Increased risk of QTc prolongation ( ECG)
3. Increased risk of clostridium difficile infection.

The causative agent for asymptomatic bacteriuria:

1. Escherichia coli
2. Enterobacteriaceae
3. Pseudomonas aerginosa
4. Enterococcus
5. Streptococcus

Asymptomatic bacteriuria is seen in:

1. Healthy premenopausal women
2. Pregnant women
3. Postmenopausal women
4. Patient with diabetes
5. Old age
6. Long-term care residents
7. Patients undergoing hemodialysis
8. Patients with spinal cord injuries
9. Patients with indwelling catheter.