How do you guys interpret a UA with + nitrite, + bacteria and no WBC?
I know nitrite is specific for Gram negs and I've always considered this worthy of treatment even in the absence of pyuria (and anecdotally it seems the UCx almost always return + for > 100K of some GN bacteria with these).
I admitted a pt recently with presumed sepsis, only revealing source was a UA (straight cath sample) with above findings and I initiated tx as such.
ID consult obtained during hospital course and they remarked that urinary source unlikely given no pyuria (and this was after a UCx grew >100k E.coli).
Had another case yesterday of a confused elderly guy with UA + nitrite and bact, no wbc, I gave ceftriaxone and admitted. Admitting team underwhelmed and holding further abx. I follow up today and UCx >100k Klebsiella.
Thoughts?
I know nitrite is specific for Gram negs and I've always considered this worthy of treatment even in the absence of pyuria (and anecdotally it seems the UCx almost always return + for > 100K of some GN bacteria with these).
I admitted a pt recently with presumed sepsis, only revealing source was a UA (straight cath sample) with above findings and I initiated tx as such.
ID consult obtained during hospital course and they remarked that urinary source unlikely given no pyuria (and this was after a UCx grew >100k E.coli).
Had another case yesterday of a confused elderly guy with UA + nitrite and bact, no wbc, I gave ceftriaxone and admitted. Admitting team underwhelmed and holding further abx. I follow up today and UCx >100k Klebsiella.
Thoughts?