We appreciate the comments made by de St Maurice et al, regarding our work on the association between pyuria and Enterococcus. We agree with their stated concern regarding both overdiagnosis and overtreatment of bacteriuria in asymptomatic children. However, as stated in our conclusion, we were focused on the interpretation of urinalysis in symptomatic children.

Distinguishing UTI from urinary tract colonization is currently challenging given the lack of specific markers to differentiate these 2 conditions. Thus, clinicians rely on the child’s symptoms and the urinalysis. However, if we are using the urinalysis to differentiate between infection and colonization of the urinary tract, it is critical to understand its limitations. With our data, we attempt to provide clarity on this issue by providing empirical evidence of the limitations of the urinalysis, which raises questions as to whether it should be used to determine the need for a urine culture in children with neurogenic bladders. Accordingly, we stand by our conclusion that in a symptomatic child at risk for UTI, urine culture should be performed irrespective of the results of the urinalysis.

We appreciate the opportunity to discuss the results of this work and to engage in discourse that may help improve the care of these children.

Competing Interests

CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.