Related Experiment Video
Updated: Oct 4, 2025
Establishment and Characterization of UTI and CAUTI in a Mouse Model
Published on: June 23, 2015
Association of Pyuria with Uropathogens in Young Children
Shahid Nadeem1, Matthias M Manuel2, Oluwaseun K Oke3
1PM Pediatrics Urgent Care, Richardson, TX.
Insights
Pyuria and leukocyte esterase are insensitive markers for identifying non-Escherichia coli urinary tract infections (UTIs) in young children. New biomarkers are needed to detect UTIs caused by these uropathogens.
Area of Science:
- Pediatric infectious diseases
- Clinical microbiology
- Diagnostic biomarkers
Background:
- Urinary tract infections (UTIs) are common in children under 24 months.
- Accurate diagnosis of UTI is crucial for timely treatment and preventing complications.
- Current diagnostic markers like pyuria may lack sensitivity for certain uropathogens.
Purpose of the Study:
- To investigate the association between specific uropathogens and the presence of pyuria in children under 24 months.
- To evaluate the diagnostic utility of pyuria and leukocyte esterase for identifying non-Escherichia coli UTIs.
Main Methods:
- Retrospective study of children <24 months with suspected UTI.
- Analysis of paired urinalysis and urine culture results from emergency department evaluations.
- Exclusion of contaminated specimens and focus on culture-confirmed UTIs based on AAP guidelines.
Main Results:
- In 1916 children with confirmed UTI, pyuria was present in 88.2% and positive leukocyte esterase in 88.3%.
- Children with non-E. coli infections were significantly less likely to exhibit pyuria compared to E. coli infections.
- This reduced likelihood was more pronounced for Enterococcus and Klebsiella species.
Conclusions:
- Pyuria and leukocyte esterase are not sensitive indicators for non-E. coli UTIs in young children.
- The findings highlight a need for improved diagnostic biomarkers to detect UTIs caused by less common uropathogens.
- Development of more sensitive screening tools is essential for accurate UTI diagnosis in this age group.
Objective:
To examine the association between uropathogens and pyuria in children <24 months of age.
Study Design:
A retrospective study of children <24 months of age evaluated in the emergency department for suspected urinary tract infection (UTI) with paired urinalysis and urine culture during a 6-year period. Bagged urine specimens or urine culture growing mixed/multiple urogenital organisms were excluded. Analysis was limited to children with positive urine culture as defined by the American Academy of Pediatrics clinical practice guideline culture thresholds.
Results:
Of 30 462 children, 1916 had microscopic urinalysis and positive urine culture. Urine was obtained by transurethral in-and-out catheterization in 98.3% of cases. Pyuria (≥5 white blood cells per high-powered field) and positive leukocyte esterase (small or more) on the urine dipstick were present in 1690 (88.2%) and 1692 (88.3%) of the children respectively. Children with non-Escherichia coli species were less likely to exhibit microscopic pyuria than children with E coli (OR 0.24, 95% CI 0.17-0.34) with more pronounced effect on Enterococcus and Klebsiella (OR 0.08, 95% CI 0.03-0.18 and OR 0.18, 95% CI 0.11-0.27 respectively). Similarly, positive leukocyte esterase was less frequently seen in non-E coli uropathogens compared with E coli.
Conclusions:
Pyuria and leukocyte esterase are not sensitive markers to identify non-E coli UTI in young children. More sensitive screening biomarkers are needed to identify UTI with these uropathogens.
More Related Videos
08:53Recurrent Escherichia coli Urinary Tract Infection Triggered by Gardnerella vaginalis Bladder Exposure in Mice
Published on: December 4, 2020
07:34Isolation of Single Intracellular Bacterial Communities Generated from a Murine Model of Urinary Tract Infection for Downstream Single-cell Analysis
Published on: April 16, 2019
Related Concept Videos
01:25Urinary Tract Infection II: Pathophysiology
01:27Acute Pyelonephritis I: Introduction
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Urinary Tract Infection I: Introduction
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:26Urine Studies II: Urine Culture and Sensitivity Test