Fever, bacteriuria, and pyuria in spinal cord injured patients with indwelling urethral catheters

Little is known about the significance of pyuria in spinal cord injury patients with indwelling urethral catheters (IUCs). The hospital courses of 32 such patients admitted to a rehabilitation hospital from January 1986 to December 1987 were reviewed to determine the incidence of unexplained febrile episodes, i.e., no obvious nonurinary source of infection. All patients had positive admission urine cultures (>100,000 colony-forming units/mL). Patients were divided into two groups based on the level of pyuria in admission urinalyses. Group A (the low pyuria group) was composed of 22 patients with ≤50 white blood cells per high-power field (WBC/HPF). Group B (the high pyuria group) was composed of ten patients with >50 WBC/HPF. None were admitted to the rehabilitation program taking antibiotics; none were prophylactically treated for urinary tract infection. Group A had an incidence of 3/22 (13.6%) febrile episodes. Group B had an incidence of 6/10 (60%) febrile episodes. The difference in incidence of fever between the groups was statistically significant (x² = 7.31, p <.01). These results suggest that SCI patients with IUCs and gross pyuria may be at risk for increased morbidity secondary to untreated urinary tract infection.