Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis

Abstract

BackgroundClinicians should be aware of the diagnostic values of various symptoms, signs and antecedents. This information is particularly important in primary care settings, where sophisticated diagnostic approaches are not always feasible. The aim of the study is to determine the probability that various symptoms, signs, antecedents and tests predict urinary tract infection (UTI) in women.MethodsWe conducted a systematic search of the MEDLINE and EMBASE databases to identify articles published in all languages through until December 2008. We particularly focused on studies that examined the diagnostic accuracy of at least one symptom, sign or patient antecedent related to the urinary tract. We included studies where urine culture, a gold standard, was preformed by primary care providers on female subjects aged at least 14 years. A meta-analysis of the likelihood ratio was performed to assess variables related to the urinary tract symptoms.ResultsOf the 1, 212 articles identified, 11 met the selection criteria. Dysuria, urgency, nocturia, sexual activity and urgency with dysuria were weak predictors of urinary tract infection, whereas increases in vaginal discharge and suprapubic pain were weak predictors of the absence of infection. Nitrites or leukocytes in the dipstick test are the only findings that clearly favored a diagnosis of UTI.ConclusionsClinical findings do not aid in the diagnosis of UTI among women who present with urinary symptoms. Vaginal discharge is a weak indicator of the absence of infection. The urine dipstick test was the most reliable tool for detecting UTI.

Practice Guidelines for Primary Care of Acute Abdomen 2015

“…Urinary tract infection is common, particularly in women, and bacterial infection is the most frequent in primary care. According to a systematic review, the presence of urinary nitrite has a positive LR of 6.51 and negative LR of 0.58 for the detection of urinary infection in women, whereas the positive LR of symptoms such as frequent urination, pyuria, suprapubic pain, flank pain, and fever ranged between 0.58 and 1.14 (level 1).…”

Systematic reviews and meta-analyses of diagnostic test accuracy

“…We hope to explain for readers what they can expect from a diagnostic accuracy review, and how the results of these reviews can be used in clinical and laboratory practice. A selection of 20 diagnostic test accuracy reviews in infectious diseases will serve as an illustration [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] (see Appendix). These reviews come from a set of reviews published between September 2011 and January 2012 that we used to survey which meta-analytic methods authors use [26].…”

The role of point‐of‐care tests in antibiotic stewardship for urinary tract infections in a resource‐limited setting on the Thailand–Myanmar border

“…History alone has a diagnostic sensitivity between 50% and 80%, and multiple algorithms used in different studies have made clinical assessment of UTI difficult to compare . Clinical examination is not useful in diagnosing UTI as opposed to pyelonephritis. Urine dipstick is routine practice in many countries for initially investigating a UTI and a meta‐analysis (of 70 publications) concluded that a urine dipstick that was negative for both nitrites and leucocyte esterase was useful in all populations to exclude the presence of infection .…”