My 70 year old male patient with recent hip fracture has developed fevers with sterile pyuria. How do I interpret the sterile pyuria in this patient?

Although historically sterile pyuria has been associated with genitourinary (GU) tuberculosis, there are many more common causes to consider in the hospitalized patient. 

Recent antibiotic exposure (within past 2 weeks) in the setting of UTI is one of the most frequent causes.  Prostatitis is also an often overlooked cause.  About 15% of hospitalized patients with systemic infections outside of the GU tract (e.g. pneumonia) may also have sterile pyuria. Non-infectious causes include current or recent catheterization of bladder, urinary stones, stents, GU malignancy, papillary necrosis,  and analgesic nephropathy. 

I would start out with a prostate exam.

Reference:

Wise GJ, Schlegel PN. Sterile pyuria. N Engl J Med 372;11:1048-54.

My 70 year old male patient with recent hip fracture has developed fevers with sterile pyuria. How do I interpret the sterile pyuria in this patient?

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