PYURIA AMONG CHRONICALLY INCONTINENT BUT OTHERWISE ASYMPTOMATIC NURSING-HOME RESIDENTS

OBJECTIVE: To determine the prevalence of pyuria and its relationship to bacteriuria in a representative sample of chronically incontinent n ursing home residents. DESIGN: Prospective, descriptive case series. S ETTING: Six nursing homes. PARTICIPANTS: Two hundred fourteen chronica lly incontinent, but otherwise asymptomatic, nursing home residents wh o were enrolled in a clinical intervention trial for urinary incontine nce. MEASURES: Two hundred fourteen urine specimens were collected by a validated clean catch technique. Each specimen underwent dipstick te sting for leukocyte esterase, microscopic urinalysis to determine the number of white blood cells per high power field of centrifuged urine, and quantitative urine culture using standard laboratory techniques. RESULTS: The overall prevalence of pyuria was 45%, as defined by >10 w hite blood cells per high field of spun urine, and the overall prevale nce of bacteriuria was 43%, as defined by the growth of >100,000 colon y forming units of a urinary pathogen. Fifty-nine percent of the speci mens with bacteriuria and 34% of the specimens without bacteriuria had pyuria. Of specimens with pyuria, 56% had bacteriuria, and of specime ns without pyuria, 31% had bacteriuria. When any color change on the l eukocyte esterase pad was considered positive, this finding had a sens itivity of 83% and a specificity of 52% for pyuria on microscopic urin alysis. CONCLUSIONS: Pyuria is common among chronically incontinent nu rsing home residents, both in the presence and absence of bacteriuria, Clinicians must therefore be cautious in interpreting the presence of pyuria to indicate symptomatic infection in this population. Using py uria to determine the need for antimicrobial treatment could result in unnecessary expense and morbidity as well as contribute to the develo pment of resistant organisms in nursing homes. Research is needed to d efine pyuria better, to determine its prevalence and relationship to b acteriuria among nursing home residents with symptoms of acute urinary tract infection, and to elucidate the etiology and significance of st erile pyuria in this population.