Pyuria as a Clinically Relevant Urinary Marker Associated with Clinical Suspicion of Neonatal Urinary Tract Infection in Suprapubic Aspiration Samples: A Retrospective Study from Tobruk, Libya
DOI:
https://doi.org/10.54361/LJMR.20.3.106Keywords:
Pyuria, Neonatal urinary tract infection, Suprapubic aspiration, Urinary markers, Bacteriuria, Neonatal sepsis, Diagnostic accuracy, SPA UTI-compatible, White blood cellsAbstract
Background: Urinary tract infection (UTI) is a major cause of neonatal morbidity, yet diagnosis is difficult because clinical manifestations are nonspecific. Pyuria is a long-valued indicator of UTI, but its utility in neonates, particularly with uncontaminated suprapubic aspiration (SPA) specimens, needs further investigation. Objective: To evaluate the clinical significance and utility of pyuria as the primary urinary marker for suspected neonatal UTI using SPA specimens. Methods: This retrospective observational study at Tobruk Medical Center, Libya, included 119 neonates (≤28 days) who underwent SPA urine collection between January 2024 and December 2025. Pyuria was defined as >5 white blood cells per high-power field (WBC/HPF). Associations between pyuria, bacteriuria, SPA UTI-compatible composite findings, and clinician-recorded UTI suspicion were assessed using Pearson Chi-square and Fisher’s exact tests, Results: Pyuria was present in 46 of 119 neonates (38.7%; 95% CI: 30.4%–47.6%), the most frequent urinary abnormality, compared with bacteriuria (33.8%) and SPA UTI-compatible findings (20.3%). Mild pyuria predominated (22.7%), followed by moderate (9.2%) and marked (6.7%). Pyuria was strongly associated with clinician-recorded UTI suspicion: all neonates with documented UTI (5/5) had pyuria, versus 29 of 85 (34.1%) without (Fisher’s exact test, P = 0.006). Neither bacteriuria (P = 1.000) nor the composite (P = 0.518) was significantly associated. Pyuria was not associated with antibiotic regimen (P = 0.812), Conclusion: Pyuria is the most clinically relevant urinary marker for suspected neonatal UTI in SPA specimens, supporting routine diagnostic use; however, urine culture and comprehensive clinical evaluation remain essential. Prospective studies should validate optimal pyuria thresholds.
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