Tipo:	Trabalho de Conclusão de Curso
Título:	Piúria como marcador diagnóstico em infecções do trato urinário em pacientes com bexiga neurogênica: uma revisão sistemática
Autor(es):	Fernandes, Laísa Caldas
Primeiro Orientador:	Silva, Miralba Freire de Carvalho Ribeiro da
Resumo:	Pyuria as a diagnostic marker of urinary tract infection (UTI) in patients with neurogenic bladder remains highly controversial. In this population, UTI is common, frequently recurrent, and coexists with high rates of asymptomatic bacteriuria, making accurate diagnosis clinically and epidemiologically relevant. Chronic inflammation of the lower urinary tract—driven by neurological injury, altered urothelial and immune responses, high post-void residuals, vesicoureteral reflux, and repeated catheterization—means that pyuria may persist in the absence of true infection. We conducted a narrative systematic review, following PRISMA recommendations, of studies indexed in PubMed, Cochrane, BVS and Embase up to October 2025, using predefined criteria to identify original studies that evaluated pyuria as a diagnostic marker of UTI in patients with neurogenic bladder. Of 583 records identified, 12 met inclusion criteria. Across studies, there was marked heterogeneity in UTI definitions (symptom sets, bacteriuria thresholds) and pyuria cut-offs and measurement methods. Overall, pyuria showed modest sensitivity and limited specificity for culture-confirmed UTI, with consistently high negative predictive value when absent, but poor positive predictive value when present—particularly in chronically catheterized or colonized patients. In several cohorts, similar pyuria rates were observed in febrile and afebrile episodes, and a substantial proportion of asymptomatic individuals had persistent pyuria and bacteriuria. Available evidence therefore supports pyuria as an adjunctive, but not definitive, marker: its absence helps to exclude UTI, whereas its presence alone is insufficient to distinguish symptomatic infection from asymptomatic bacteriuria. In clinical practice, pyuria and urine culture should be interpreted in the context of compatible (often atypical) symptoms and risk factors, avoiding antibiotic treatment of isolated pyuria or asymptomatic bacteriuria, and prioritizing optimization of bladder management and catheter use. The scarcity of recent, methodologically robust studies and the lack of standardized diagnostic criteria underscore the need for contemporary research and novel biomarkers to improve diagnostic accuracy for UTI in patients with neurogenic bladder.
Palavras-chave:	Pyuria Urinary tract infection UTI Neurogenic Bladder Diagnosis Intermittent Catheterization
CNPq:	CNPQ::CIENCIAS DA SAUDE
Idioma:	por
País:	Brasil
Editora / Evento / Instituição:	Hospital Universitário Professor Edgard Santos
Sigla da Instituição:	Hupes
metadata.dc.publisher.department:	Faculdade de Medicina da Bahia
Tipo de Acesso:	Acesso Restrito
URI:	https://repositorio.ufba.br/handle/ri/43819
Data do documento:	15-Dez-2025
Aparece nas coleções:	Trabalho de Conclusão de Curso (Especialização) - Programa de Residência Médica (Faculdade de Medicina)

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