Reagent strip diagnosis of UTI in a high-risk population

Eidelman, Yelena; Raveh, David; Yinnon, Amos M.; Ballin, Joel; Rudensky, Bernard; Gottehrer, Nathan P.

doi:10.1053/ajem.2002.31145

Cited by 17 publications

(15 citation statements)

References 8 publications

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“…However, the sensitivity of NT in all three urine dipsticks was found to be low at 45.1%, 46.8% and 43.7 respectively. Our observations are supported by previous studies in which the NT test has been found to have high specificity and low sensitivity (below 30%) 11,12 , while the study by Kacmaz and colleagues 13 found the sensitivity of NT to be relatively high (60%).…”

Section: Resultssupporting

confidence: 90%

Validation of rapid tests to detect urinary tract infection

Manoharan¹,

Kumanan²,

Murugananthan³

2016

Sri Lankan J Infec Dis

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There are several rapid dip stick tests currently in use to detect urinary tract infection (UTI). This study was carried out to validate three different dip sticks that are widely used with urine culture which is the gold standard to diagnose UTI. The findings of the current study suggest that the sensitivity, specificity and predictive value of the three dipsticks are not statistically different from each other and are comparable to sedimentary microscopy. These these three dipsticks can therefore be used instead of urinary sedimentation method. However low positive predictive value (PPV) of all three dipsticks is a major limitation. Further studies with large sample size are needed to evaluate their value in clinical practice.

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Section: Resultssupporting

confidence: 90%

Validation of rapid tests to detect urinary tract infection

Manoharan¹,

Kumanan²,

Murugananthan³

2016

Sri Lankan J Infec Dis

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“…Eidelman and colleagues reported that reagent strips lacked sensitivity in the ED setting, even in high pre-test probability patients, and could therefore not rule out a UTI. 7 Similarly, Lammers and others showed that when physicians relied on the reagent strip alone to evaluate patients with classic lower urinary tract symptoms, 47% of patients received antibiotics inappropriately, while 11% did not receive treatment when they should have. 8 In this study, reagent strips were 64.3% and 73.7% sensitive for predicting positive urine cultures in asymptomatic and symptomatic patients, respectively.…”

Section: Discussionmentioning

confidence: 98%

Can urine cultures and reagent test strips be used to diagnose urinary tract infection in elderly emergency department patients without focal urinary symptoms?

Ducharme

Neilson

Ginn

2007

CJEM

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Objective:To compare the results of urine cultures and reagent strip testing in 2 groups of elderly emergency department (ED) patients: an asymptomatic group unlikely to have urinary tract infection (UTI), and a group who had vague symptoms and were considered at risk for UTI. Methods: We performed a prospective observational convenience study with 2 groups of 100 patients aged 65 or older. The asymptomatic group consisted of afebrile patients presenting to the ED with non-infectious complaints, while the symptomatic group included patients presenting with acute confusion, weakness or fever but no apparent urinary symptoms. We defined a positive urine culture as a single organism count greater than 100 000 CFU/mL in mid-stream specimens, or greater than 1000 CFU/mL in catheter specimens. We considered reagent strips positive if they demonstrated any reaction to the leukocyte-esterase assay, the nitrite assay or both. Results: Of the 33 positive cultures, 10 had negative reagent strips. Thirteen of the 14 positive nitrite tests were culture positive for a specificity of 92.8% and a sensitivity of 36.1%. Positive cultures did not infer a diagnosis of UTI. Of the 67 positive reagent strips, 41 (61.2%) were associated with negative cultures. Likelihood ratios (LRs) in both groups affirmed the inability of the reagent strips to help significantly in decision making, with positive and negative LR in the indeterminate range (control group: 2.8 and 0.31, symptomatic group: 2.7 and 0.46, respectively). Conclusion: In the elderly, reagent testing is an unreliable method of identifying patients with positive blood cultures. Moreover, positive urine culture rates are only slightly higher in patients with vague symptoms attributable to UTI than they are in (asymptomatic) patients treated for non-urologic problems, which suggests that many positive cultures in elderly patients with nonfocal systemic symptoms are false-positive tests reflecting asymptomatic bacteriuria and not UTIs. Blood cultures, regarded by many as the criterion standard for UTI, do not have sufficient specificity to confirm the diagnosis of UTI in elderly patients with non-specific symptoms.

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“…The diagnosis is complicated by the frequent presence of asymptomatic bacteriuria in elders 6,18,19 . Diagnostically, urine dipsticks have shown to be poorly predictive of positive urine cultures in multiple settings 6,7,20 . Additionally, a positive culture itself may represent asymptomatic bacteriuria rather than acute infection, and culture results are rarely available in the ED 18,19 …”

Section: Discussionmentioning

confidence: 99%

“…This complicates care for these patients, as there are currently no widely accepted criteria for diagnosis of UTI in adults 65 years and over in the ED setting. Studies have found that urine dipsticks are often inaccurate in this population, culture results are generally not available, and the test characteristics of both genitourinary and atypical symptoms are unclear 2,6,7 …”

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confidence: 99%

Age, Nursing Home Residence, and Presentation of Urinary Tract Infection in U.S. Emergency Departments, 2001–2008

Caterino

Ting

Sisbarro

et al. 2012

Academic Emergency Medicine

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Objectives: Current outpatient diagnostic algorithms for urinary tract infection (UTI) in older adults require the presence of classic signs and symptoms of UTI, such as fever and genitourinary symptoms. However, older adults with UTI may present with atypical signs and symptoms. The objective was to identify the associations of age and nursing home status with the clinical presentation of emergency department (ED) patients diagnosed with UTI.Methods: This was a retrospective, cross-sectional analysis of the 2001-2008 National Hospital Ambulatory Medical Care Survey (NHAMCS), ED component. Participants were adult ED patients diagnosed with UTI. Outcome variables were presence of fever, altered mental status, and urinary tract symptoms. Multivariable logistic regression models were constructed for each outcome. Age and nursing home status were the independent variables of interest. Age was divided into adults 18 to 64 years, older adults 65 to 84 years, and oldest adults 85 years of age and older.Results: There were 25.4 million ED visits in which UTI was diagnosed from 2001 through 2008, including 5.0 million in older adults and 2.2 million in the oldest adults. Fever was present in 13% of adults, 21% of older adults, and 19% of the oldest adults. Altered mental status was present in 1% of adults, 7% of older adults, and 13% of the oldest adults. Urinary tract symptoms were identified in 32% of adults, 24% of older adults, and 17% of the oldest adults. In multivariable analysis, altered mental status was more common in older adults (odds ratio [OR] = 1.94) and in the oldest adults (OR = 2.49). Urinary tract symptoms were less common in older adults (OR = 0.60) and the oldest adults (OR = 0.48). Nursing home residence was associated with increased fever (OR = 1.63) and altered mental status (OR = 4.79) and with decreased urinary tract symptoms (OR = 0.35).Conclusions: Fever and urinary tract symptoms are absent in a large proportion of adults over 65 years of age diagnosed with UTI in the ED. Age over 65 years and nursing home residence are associated with increased presence of altered mental status and with lack of urinary tract symptoms. Nursing home residence is also associated with increased presence of fever. Emergency physicians (EPs) continue to diagnose UTI in patients without classic symptoms. Diagnostic criteria for UTI among adults 65 years and over specifically designed for use in the acute care setting should be developed and validated to prevent both inappropriate overdiagnosis and underdiagnosis of UTI.

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Reagent strip diagnosis of UTI in a high-risk population

Cited by 17 publications

References 8 publications

Validation of rapid tests to detect urinary tract infection

Validation of rapid tests to detect urinary tract infection

Can urine cultures and reagent test strips be used to diagnose urinary tract infection in elderly emergency department patients without focal urinary symptoms?

Age, Nursing Home Residence, and Presentation of Urinary Tract Infection in U.S. Emergency Departments, 2001–2008

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