Pyuria in institutionalized elderly subjects

Two hundred and forty-three urine specimens from 76 elderly institutionalized residents were obtained for urine culture, quantitative leukocyte count and urinalysis. Significant bacteriuria was present in 153 specimens (63%), including 33 (22%) with more than one organism. Pyuria (greater than or equal to 10 leukocytes/mm3) was present in 214 specimens (88%), including 116 (97%) with single organism bacteriuria, 27 (82%) with multiple organism bacteriuria, and 71 (80%) without significant bacteriuria. The leukocyte esterase test had a positive predictive value of 99% for pyuria but a negative predictive value of only 30%. The quantitative level of pyuria was associated with the level of proteinuria and inversely with pH. A relatively constant level of pyuria tended to persist over months to years in a given individual if bacteriuria persisted. Pyuria is significantly associated with bacteriuria in the institutionalized elderly, but is also common in the nonbacteriuric. The clinical significance of pyuria requires further assessment

Diarrhea recurrence in patients with Clostridium difficile-associated diarrhea: Role of concurrent antibiotics

OBJECTIVE: To monitor prospectively patients with Clostridium difficile-associated diarrhea (CAD) in a six hundred bed tertiary care hospital to determine which factors influenced the recurrence of the diarrhea