Is a urinalysis showing trace leukocyte esterase, 7-10 white blood cells (WBCs), 7-10 epithelial cells, and 1+ bacteria, along with a patient's symptoms of dysuria and leukocytosis (elevated WBC count of 13.5), more consistent with a urinary tract infection (UTI) or contamination?

Interpretation of Urinalysis Results

This urinalysis is most consistent with contamination rather than a true UTI, despite the patient's dysuria and leukocytosis. The high epithelial cell count (7-10 cells) is the key indicator of a poorly collected specimen, and the urinalysis findings fall below the diagnostic thresholds for UTI.

Critical Analysis of the Urinalysis Findings

Evidence Against UTI

• The WBC count of 7-10/HPF falls below the diagnostic threshold for pyuria, which requires ≥10 WBCs/HPF to warrant proceeding with urine culture 1, 2
• The trace leukocyte esterase is insufficient for UTI diagnosis, as guidelines recommend only ordering urine culture when pyuria (≥10 WBCs/HPF) or a clearly positive leukocyte esterase test is present 1, 2
• The presence of 7-10 epithelial cells strongly suggests contamination from improper specimen collection, as high epithelial cell counts indicate perineal/vaginal contamination rather than bladder pathology 3

The Peripheral Leukocytosis Context

• The peripheral WBC count of 13.5 (×10³/mm³) is below the threshold for bacterial infection in older adults, where leukocytosis is defined as ≥14,000 cells/mm³ with a likelihood ratio of 3.7 for documented bacterial infection 1
• This mild elevation could represent stress response, dehydration, or another inflammatory process unrelated to UTI 1

Recommended Diagnostic Approach

Immediate Next Steps

• Obtain a properly collected urine specimen using midstream clean-catch technique or, if the patient cannot cooperate adequately, consider in-and-out catheterization for women to avoid contamination 1
• Repeat urinalysis on the properly collected specimen before making treatment decisions, as automated urinalysis indices are often abnormal in disease-free women even with ideal collection technique 3

When to Treat Based on Symptoms

• The European Association of Urology recommends prescribing antibiotics ONLY if dysuria is accompanied by urinary frequency, urgency, new incontinence, systemic signs (fever >100°F/37.8°C, shaking chills, hypotension), or costovertebral angle pain/tenderness 4, 5
• If dysuria is isolated without these additional features, do NOT prescribe antibiotics for presumed UTI—instead, evaluate for alternative causes such as vaginitis, urethritis, or chemical irritation 4

Clinical Decision Algorithm

1. Assess for accompanying UTI symptoms beyond dysuria alone (frequency, urgency, fever, flank pain) 4, 6
2. If additional symptoms are present: Recollect urine specimen properly and repeat urinalysis 1
3. If repeat urinalysis shows ≥10 WBCs/HPF or clearly positive leukocyte esterase: Proceed with urine culture and initiate empiric antibiotics 1, 2
4. If dysuria is isolated without other UTI symptoms: Evaluate for vaginal discharge, irritation, or other non-infectious causes, as these significantly decrease UTI probability (LR 0.2-0.3) 6

Common Pitfalls to Avoid

• Do not treat based on contaminated specimens with high epithelial cell counts, as this leads to unnecessary antibiotic use and promotes resistance 3
• Do not assume pyuria or positive dipstick tests indicate infection without clinical symptoms, as these findings are common in asymptomatic bacteriuria which does not require treatment 4, 2
• Recognize that contemporary automated urinalysis indices are frequently abnormal in disease-free women (50% had >trace leukocyte esterase, 77.5% had bacteria on non-clean specimens) even without infection 3
• The combination of dysuria plus frequency without vaginal symptoms has a positive likelihood ratio of 24.6 for UTI, making it the most powerful clinical predictor—use symptom combinations rather than isolated findings 6