{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:26:09Z","timestamp":1790792769834,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"Netherlands Organisation for Health Research and Development","doi-asserted-by":"publisher","award":["10150511910054"],"award-info":[{"award-number":["10150511910054"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary tract infection (UTI) in older women. The presence of pyuria remains the cornerstone of UTI diagnosis. However, &amp;gt;90% of ASB patients have pyuria, prompting unnecessary treatment. We quantified pyuria by automated microscopy and flowcytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for UTI in older women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women \u226565 years with \u22652 new-onset LUTS and 1 uropathogen \u2265104 colony-forming units (CFU)\/mL were included in the UTI group. Controls were asymptomatic and classified as ASB (1 uropathogen \u2265105 CFU\/mL), negative culture, or mixed flora. Patients with an indwelling catheter or antimicrobial pretreatment were excluded. Leukocyte medians were compared and sensitivity\u2013specificity pairs were derived from a receiver operating characteristic curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 164 participants. UTI patients had higher median urinary leukocytes compared with control patients (microscopy: 900 vs 26 leukocytes\/\u00b5L; flowcytometry: 1575 vs 23 leukocytes\/\u00b5L; P &amp;lt; .001). Area under the curve was 0.93 for both methods. At a cutoff of 264 leukocytes\/\u00b5L, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leukocytes\/\u00b5L had a poor specificity (36%) and a sensitivity of 100%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The degree of pyuria can help to distinguish UTI in older women from ASB and asymptomatic controls with pyuria. Current pyuria cutoffs are too low and promote inappropriate UTI diagnosis in older women.<\/jats:p>\n                    <jats:p>Clinical Trials Registration. International Clinical Trials Registry Platform: NL9477 (https:\/\/trialsearch.who.int\/Trial2.aspx?TrialID=NL9477)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciad099","type":"journal-article","created":{"date-parts":[[2023,2,19]],"date-time":"2023-02-19T23:09:33Z","timestamp":1676848173000},"page":"2070-2076","source":"Crossref","is-referenced-by-count":42,"title":["Current Pyuria Cutoffs Promote Inappropriate Urinary Tract Infection Diagnosis in Older Women"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8877-3144","authenticated-orcid":false,"given":"Manu P","family":"Bilsen","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Leiden University Medical Center , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaretha J","family":"Aantjes","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Leiden University Medical Center , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"van Andel","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janneke E","family":"Stalenhoef","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, OVLG , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cees","family":"van Nieuwkoop","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haga Teaching Hospital , The Hague , The Netherlands"},{"name":"Department of Public Health and Primary Care, Leiden University Medical Center , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliane M S","family":"Leyten","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haaglanden Medisch Centrum , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie M","family":"Delfos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Alrijne Hospital , Leiderdorp , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Sijbom","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattijs E","family":"Numans","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilco P","family":"Achterberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon P","family":"Mooijaart","sequence":"additional","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha T","family":"van der Beek","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Leiden University Medical Center , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa M","family":"Cobbaert","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon P","family":"Conroy","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo G","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Leiden University Medical Center , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel M C","family":"Lambregts","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Leiden University Medical Center , Leiden , The 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