Pyuria
|
Pyuria |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
To view a comprehensive algorithm of common findings of urine composition and urine output, click here
Overview
Definition
Pyuria is a condition in which urine contains pus. Definition of pyuria is as follow:[1]
- Presence of 10 or more white cells/mm³ in a urine specimen
- Positive result on Gram’s stain of an unspun urine specimen
- Positive leukocyte esterase on urinary dipstick test
Pyuria might be a sign of a bacterial or non bacterial urinary tract infection.
Classification
Pyuria may be classified based on the presence of detectable infection as shown below:[2][3]
| Classification of pyuria | |||
|---|---|---|---|
| Group | Cell count | Bacteria | Etiology |
| Sterile pyuria | ↑ | - | Might have infectious or non-infectious etiologies. |
| Bacteriuria | ↑ | Positive bacterial colony >1000 colony-forming units/ml | Mostly have infectious etiologies. |
Pyuria Differential Diagnosis
Treatment
- Sterile pyuria
- . Pathogen-directed antimicrobial therapy[4]
- Renal Tuberculosis
- Preferred regimen: (Isoniazid 300 mg PO qd for 2 months AND Rifampicin 450-600 mg qd for 2 months AND Ethambutol 15-25 mg/kg PO qd for 2 months AND Pyrazinamide 1500 mg for 2 months) THEN (Isoniazid 300 mg PO qd for 4-6 months AND Rifampicin 450-600 mg qd for 4-6 months)
- Gonorrhea
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose THEN (Azithromycin 1 g PO in a single dose OR Doxycycline 100 mg PO bid for 7 days)
- Chlamydia
- Preferred regimen: Azithromycin 1 g PO in single dose OR Doxycycline 100 mg PO bid for 7 days
- Alternative regimen: Erythromycin base 500 mg PO qid for 7 days
- Mycoplasma and Ureaplasma
- Preferred regimen: Azithromycin OR Levofloxacin OR Moxifloxacin
- Genital herpes
- Preferred regimen: Acyclovir 400 mg PO tid for 7–10 days or Acyclovir 200 mg PO five times a day for 7–10 days OR Famciclovir 250 mg PO tid for 7–10 days OR Valacyclovir 1 g PO bid for 7 days
- Trichomoniasis
- Preferred regimen: Metronidazole 2 g PO in a single dose OR Tinidazole 2 g PO in a single dose
- Note: Treat patient’s sex partner if trichomoniasis is diagnosed in patient.
- Fungal infections[5]
- Preferred regimen, Candida albicans: Fluconazole 100 mg PO qd for 2-5 days
- Preferred regimen, non-albicans Candida: Amphotericin B 0.1 mg/kg/day IV for 2-5 days OR Amphotericin B bladder irrigation 5-50 mg/L of sterile water qd for 2-5 days
- Schistosomiasis
- Preferred regimen: Praziquantel 20 mg/kg PO bid for 1–2 days
References
- ↑ Horan, Teresa C.; Andrus, Mary; Dudeck, Margaret A. (2008-06). "CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting". American Journal of Infection Control. 36 (5): 309–332. doi:10.1016/j.ajic.2008.03.002. ISSN 1527-3296. PMID 18538699. Check date values in:
|date=(help) - ↑ Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.
- ↑ Kwon, Jennie H.; Fausone, Maureen K.; Du, Hongyan; Robicsek, Ari; Peterson, Lance R. (2012-05). "Impact of laboratory-reported urine culture colony counts on the diagnosis and treatment of urinary tract infection for hospitalized patients". American Journal of Clinical Pathology. 137 (5): 778–784. doi:10.1309/AJCP4KVGQZEG1YDM. ISSN 1943-7722. PMID 22523217. Check date values in:
|date=(help) - ↑ Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.
- ↑ Jacobs LG, Skidmore EA, Freeman K, Lipschultz D, Fox N (1996). "Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients". Clin Infect Dis. 22 (1): 30–5. PMID 8824962.