From the Guidelines
The patient's urinalysis results indicate a possible urinary tract infection (UTI) due to the presence of bacteria at greater than 20 per high power field (>20/HPF), despite normal white blood cell (WBC) and red blood cell (RBC) counts. The urinalysis microscopic examination shows normal WBC count (0-5/HPF) and RBC count (0-2/HPF) in the urine. Squamous/transitional epithelial cells are also within normal range (0-5/HPF). However, bacteria are present at greater than 20 per high power field (>20/HPF), which is abnormal (normal range is 0-20/HPF). Some key points to consider in the diagnosis and treatment of UTIs include:
- The European Association of Urology guidelines recommend urinalysis, including assessment of white and red blood cells and nitrite, for routine diagnosis of UTIs 1.
- The guidelines also recommend prompt differentiation between uncomplicated and potentially obstructive pyelonephritis, as the latter can swiftly progress to urosepsis 1.
- Fluoroquinolones and cephalosporins are recommended for oral empiric treatment of uncomplicated pyelonephritis, while other agents such as nitrofurantoin, oral fosfomycin, and pivmecillinam should be avoided due to insufficient data on their efficacy 1.
- A urine culture should be considered to identify the specific bacteria and determine antibiotic sensitivity, especially if the patient has recurrent UTIs, is pregnant, male, or has complicated factors 1. Treatment should be tailored to local policies and resistance patterns, and may involve antibiotics such as fluoroquinolones or cephalosporins, as well as increased fluid intake to help flush bacteria from the urinary tract. It is essential to note that the presence of bacteria without elevated WBCs could sometimes represent contamination during sample collection, so clinical correlation is crucial 1.
From the Research
Urinalysis Results
The provided urinalysis results show the following:
- WBC, Urine: 0-5 /HPF, which is within the reference range of 0-5 (/HPF) 2
- RBC, Urine: 0-2 /HPF, which is within the reference range of 0-2 (/HPF)
- Bacteria, Urine: >20 /HPF, which is abnormal as it exceeds the reference range of 0-20 (/HPF) 3, 4
- Squamous/Transitional Epithelial Cells, Urine: 0-5 /HPF, which is within the reference range of 0-5 (/HPF)
Possible Urinary Tract Infection (UTI)
The presence of bacteria in the urine (>20 /HPF) suggests a possible UTI 2, 5. According to the study by 2, bacteriuria is more specific and sensitive than pyuria for detecting UTI.
Treatment Options
The treatment options for UTI include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%) 2. Nitrofurantoin is considered a first-line therapy for uncomplicated lower urinary tract infection (UTI) 4.
Key Points to Consider
- The diagnosis of UTI should be based on symptoms and test results, including urinalysis and urine culture 2, 5
- Nitrofurantoin is effective in the prevention of UTI, but its use may be associated with increased non-severe adverse effects 6
- The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials 5