Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study

Abstract

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PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study

“…These findings are analogous to perceptions about prescriptions: GPs often perceive a pressure from patients to prescribe, investigate and refer despite the fact that patients do not report such expectations. 58 More recent findings from a qualitative study of patients attending with suspected urinary tract infection also identified patients' reluctance to rely on antibiotics to ameliorate symptoms, whereas GP interviews highlighted belief in patient pressure or desire for antibiotic prescriptions, 44,59 thus suggesting an ongoing disconnection between HCPs' views of patients' expectations and patients' expectations.…”

“…However, the variability of the performance of variables in these data sets -particularly striking for some variables such as cervical glands -suggests that such an approach is unlikely to provide the most valid method of variable selection for a clinical prediction rule, which is supported by similar findings in the development of clinical prediction rules for other acute infections. 44 The reason for this variation is unclear, but it may reflect varying infective agents, populations or clinician factors (e.g. reliability of history taking or examination).…”

Antimicrobial resistance patterns in outpatient urinary tract infections - the constant need to revise prescribing habits

“…The dipstick strategy is most likely to be cost-effective. 17 These criteria will also help to limit the unnecessary use of empiric antibiotics.…”

Urinary tract infections: diagnosis and management

“…When nitrite, LE and blood are all negative the NPV for UTI has been shown to be 76 per cent (a quarter of patients would be told that they have no UTI when in fact they do). 11 The positive predictive value (PPV) of having a positive nitrite and either blood or LE result is approximately 92 per cent. A positive dipstick tests for nitrite and/or LE is less likely to predict bacteriuria than combinations of specific symptoms of dysuria and frequency without vaginal discharge (post-test probability of UTI: 81 per cent vs 96 per cent respectively).…”

“…LE, nitrite and blood are the important tests in evaluating for UTI. 11 The diagnostic accuracy of urine dipsticks for UTI varies with clinical setting and patient group. 12,13 Generally, a nitrite test is highly specific (96-99 per cent) but poorly sensitive (44-64 per cent).…”