The Importance of Pus/ Epithelial Cells Counts in Diagnosis of Urinary Tract Infection and Asymptomatic Bacteriuria.

Background: Asymptomatic bacteriuria (ABU) is often diagnosed incidentally, and detection of bacteria in urine can lead to unnecessary antibiotic use, may aggravate antimicrobial resistance. To our knowledge, no prior study has focused on the dual presence of pus and epithelial cells (PEDP) and its diagnostic value. Objective: To evaluate the importance of Pus/ Epithelial Cells Counts in diagnosis of ABU and UTI. Methods: A case-control study was conducted on (140) females, divided into two groups: 70 with UTI and 70 apparently healthy controls, 28 had ABU and 42 had sterile urine cultures, with age ranging from (18 to over 58) years. Urine samples underwent general urine examination and bacteriological culture. Results: Positive bacterial growth occurred in 57.1% of UTI patients and 40% of controls (ABU). E. coli was the most frequent in both groups. PEDP analysis showed that 61.4% of UTI cases represented true infections, while 38.6% were likely contamination (defined as presence of pus or epithelial cells alone according to culture results). E. coli was strongly associated with true infections, whereas S. epidermidis was more common in contamination. In the ABU group, 100% of true infections showed bacteria in urine, with sensitivity, specificity, PPV, and NPV of 100.0%, 60.0%, 68.4%, and 100.0%, respectively. In the UTI group, these values were 90.6%, 63.2%, 67.4%, and 88.9%, respectively. Conclusion: PEDP could be used to differentiation of true infection from contamination in patients with UTI. Combining microscopic bacterial detection with PEDP improves diagnostic accuracy for ABU and UTI in females.