WBCs in urine

[Jade268]

Are WBCs in urine always diagnostic of a UTI? The sample was clear, negative for nitrates and leukocyte esterase but the micro did show 10-20 WBCs.

[RN403, BSN, RN]

Not always. Specimen could have been contaminated.

[BSNbeauty, BSN, RN]

We really focus on nitrates and sx of the pt. Elevated wbc is not used to soley diagnose.

[cayenne06, MSN, CNM]

Elevated WBC from a clean catch specimen is highly suggestive of a UTI. But you have to look at the whole clinical picture-a UA alone doesn't give you all the information you need, not by a long shot. The fact that the leukocyte esterase was negative makes me think it was likely contaminated by lady partsl secretions.

eta- nitrites have very high positive predictive values, but their absence doesn't rule out a UTI.

[klone, MSN, RN]

Even in a completely negative UA, if the symptoms are suggestive of UTI (dysuria, urgency, frequency, flank pain, etc), then we will treat, regardless (and we generally don't culture it unless it's a pregnant patient).

I recently had a patient come in with all the clinical sx, but negative nitrites and leuks. We treated her empirically, and her culture came back with low (10K) colonies of E. Coli. I had to eat crow, because I was arguing with the provider that if nitrites are negative, it's probably some other pathogen and it should be cultured (she wasn't going to culture it, just treat). Sure enough, it was E. Coli, but probably just not enough to convert to nitrites yet.