Is a patient with a urinary tract infection (UTI) and upper respiratory infection (URI) symptoms, including fatigue and a history of fever, considered emergent with normal white blood cell (WBC) count and slightly elevated neutrophils?

Elevated Neutrophils in a Patient with UTI and URI Symptoms: Not an Emergency

A neutrophil count of 6.8 with normal WBC count of 9.5 in a patient with UTI and URI symptoms is not an emergency and represents an expected inflammatory response to infection. 1

Assessment of Laboratory Values in the Context of Infection

• A neutrophil count of 6.8 is only slightly elevated and is consistent with a mild inflammatory response to bacterial infection, which is expected in a patient being treated for UTI 1
• The normal WBC count of 9.5 is reassuring and suggests the infection is not severe or systemic 1
• According to the Infectious Diseases Society of America guidelines, leukocytosis is defined as a WBC count >14,000 cells/mm³, which your patient does not have 1
• Significant leukocytosis (>14,000 cells/mm³) or marked left shift (bands >1,500 cells/mm³ or >16% of neutrophils) would be more concerning for severe bacterial infection 1

Interpretation of Laboratory Values in UTI

• Mild neutrophilia without leukocytosis is a common finding in uncomplicated UTIs and does not indicate an emergent condition 1, 2
• The European Association of Urology guidelines note that UTIs typically present with elevated neutrophils as part of the inflammatory response 1
• The absence of significant leukocytosis (WBC <14,000) suggests this is not a case of urosepsis, which would require more urgent intervention 1, 2
• Studies have shown that leukocytosis or leukopenia are significantly more frequent in patients with urosepsis (68% vs 29%), but your patient has neither 3

Clinical Correlation with Symptoms

• The patient's history of fever at home but normal temperature in the office suggests the infection may be responding to the body's immune response or early treatment 1, 2
• URI symptoms with fatigue are common presentations and do not necessarily indicate a more severe infection when laboratory values are only mildly abnormal 1, 2
• According to the Infectious Diseases Society of America, patients with UTI may present with fever and systemic symptoms, but the absence of significant leukocytosis is reassuring 1, 2

Monitoring Recommendations

• Continue the current UTI treatment as planned 1
• Monitor for development of warning signs that would suggest progression to urosepsis, including:
  • Fever >38.5°C (101.3°F) 1
  • Worsening leukocytosis (WBC >14,000) 1
  • Development of hypotension, tachycardia, or altered mental status 1, 2
• If the patient develops any of these signs, reassessment would be warranted 1, 2

Common Pitfalls to Avoid

• Don't assume that any elevation in neutrophils requires emergency intervention; mild elevations are expected with localized bacterial infections 1, 4
• Avoid overinterpreting laboratory values without clinical correlation; the patient's overall clinical status appears stable 2, 4
• Don't dismiss the importance of follow-up; while not emergent now, infections can progress, so appropriate monitoring is still important 1, 2
• Remember that elderly patients may not present with typical signs of infection; the absence of fever in the office doesn't rule out an active infection 1, 2