Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women

Summary: The presence of pyuria is commonly used as the cornerstone of urinary tract infection (UTI) diagnosis. However, over 90% of asymptomatic bacteriuria (ASB) patients also have pyuria, which can lead to unnecessary treatment. This is especially problematic in older women who may have pre-existing lower urinary tract symptoms, cognitive impairment, and a high prevalence of ASB. This study examined the diagnostic accuracy of different pyuria thresholds for UTI in older women. The study found that current pyuria cut-offs (10 leukocytes/µl) are too low and promote inappropriate UTI diagnosis in older women. A threshold of 300 leukocytes/µl is suggested as a considerable improvement, increasing specificity to avoid overtreatment, while still maintaining a fair sensitivity. This has implications for patient care, antimicrobial stewardship efforts, and research. The impact of higher cut-off values on prescription behavior and UTI related outcomes in older women deserves further study.

Article: Current pyuria cut-offs promote inappropriate UTI diagnosis in older women – Clinical Infectious Diseases

Related:

Bacteriuria in older adults triggers confusion in healthcare providers: A mindful pause to treat the worry – Antimicrobial Stewardship & Healthcare Epidemiology

Antibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysis – British Journal of General Practice

USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults

Most doctors still believe in prescribing unnecessary antibiotics to treat asymptomatic bacteriuria, study suggests.

Randomized trial: Antibiotics vs. no therapy in kidney transplant recipients with asymptomatic bacteriuria

Commentary on Twitter

Presence of pyuria remains the cornerstone of UTI diagnosis However, >90% of ASB patients have pyuria,prompt unnecessary Rx
?️⚡️⚡️study: current pyuria cut-off is too low promote inappropriate UTI diagnosis in older women suggesting a new higher cut offhttps://t.co/qAGdwSTiU6 pic.twitter.com/Vr63RnuMv1

— Antibiotic Steward Bassam Ghanem?? (@ABsteward) February 20, 2023

Article under a https://creativecommons.org/licenses/by-nc-nd/4.0/ license