Pyuria and bacteriuria.

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Abstract
Urine white cell counts and bacterial counts were carried out on 168 infants and children without known urinary infection or renal disease. The urine white cell count was a useful screening test for urinary infection in children, 92% of the bacteriologically negative urines (sterile or less than 10,000 organisms/ml) from all age-groups contained 15 or less cells per 1.2 mm3 (equivalent to 12 or less cells per mm3). Quantitative white cell count on centrifuged urine is a simple and satisfactory technique which can be easily performed in the side-room. Bacterial counts were reliable in older children, from whom a mid-stream specimen of urine could be obtained without much difficulty. In younger infants, if plastic bags were used for urine collection, only 60% gave bacteriologically negative results. Repeat urine cultures confirmed negative results in two-thirds of those with initial significant colony counts (100,000 organisms/ml) but normal urine white cell counts. Urine culture remains difficult in the newborn infant. Only half of the specimens were bacteriologically negative. Repeat culture tends to give a similar result if the method of cleansing is not altered. Improved methods of cleansing the perineum and of urine collection in these young infants are required if catheterization is to be avoided. The diagnosis of urinary infection may have a sounder basis if the quantitative urine white cell count is considered together with the bacterial count. A white cell count below 15 cells/1.2 c.mm. (or 12 cells/c.mm.) on a fresh urine specimen is strong evidence against an acute infection of the urinary tract. Gram-stained films are confirmed to be a quick and reliable method of forecasting bacterial counts.