Significance of pyuria and bacteria in chronic spinal cord injury Patients

ABSTRACT

Five hundred patients with chronic spinal cord injury have been studied clinically, radiologically and bacteriologically over a period of one year. Methods of urinary drainage included condom [300], catheter [63], bladder training [107] and intermittent catheterization [30]. 96% of patients had significant pyuria [>5 WBC/HPF]. Low pyuria level [5-30 WBC] was associated with 90% incidence of bacteriuria and 7.5% incidence of symptomatic urinary tract infection. Moderate pyuria [30-100 WBC] was 28%, incidence and high pyuria [>100 WBC] was 19%, incidence and both were similarly associated with 100% incidence of bacteriuria and 25% incidence of symptomatic urinary tract infection. Bacteriuria was presented in 91.2% of all patients. Symptomatic bacteriuria was presented in only 16.4% of bacteriuric patients. The most common isolated organisms were E. coli [65%] and Proteus mirabilis [22%]. In conclusion, low pyuria level [<30 WBC/HPF] has less bacteriuria and lower incidence of symptomatic urinary tract infection. On the other hand, pyuria level [>30 WBC/HPF] has a higher incidence of symptomatic infection. Symptomatic bacteriuria is presented in only 16.4% of bacteriuric patients. Antimicrobial therapy is recommended in pyuria level [>30 WBC/HPF] and symptomatic bacteriuria