The reliability and validity of using the urine dipstick test by patient self-assessment for urinary tract infection screening in spinal cord injury patients

Duanngai, Krit; Sirasaporn, Patpiya; Ngaosinchai, S.S.

doi:10.4103/2249-4863.222024

Cited by 8 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further, the present study investigated the level of agreement between nitrite and leucocyte esterase with urine culture. The agreement levels of nitrite and leucocyte esterase reported by this study were higher than those reported in Thailand [6]. In the present study, the highest agreement with urine culture was recorded for nitrite alone 87.65% (kappa = 0.351), followed by “nitrite-positive or leucocyte esterase results” 72.49 (kappa = 0.290).…”

Section: Discussioncontrasting

confidence: 77%

“…However, quantitative urine culture is laborious and requires a longer period to complete. Consequently, in most primary care settings, the use of a single (most often dipstick) or rarely two of these protocols without quantitative urine culture is often relied upon for clinical laboratory diagnosis of UTI [6, 7]. Urine culture is most often requested only when a patient is having a recurrent infection or when symptoms are quite severe.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effectiveness of Dipstick for the Detection of Urinary Tract Infection

Dadzie

Quansah

Dakorah

et al. 2019

Canadian Journal of Infectious Diseases and Medical Microbiolog

View full text Add to dashboard Cite

Background The balance between the choices of UTI diagnostic tools in most primary care settings has been settled for by the more rapid, less labour-intensive dipstick. This study aimed to evaluate the effectiveness of dipstick for diagnosing UTI. Method A total of 429 urine samples were collected from patients suspected of UTI; cultured on cysteine-lactose-electrolyte-deficient (CLED) agar, blood agar, and MacConkey agar; and incubated at 37°C overnight. Urine cultures with bacteria count ≥105 cfu/ml were classified as “positive” for UTI. A dipstick was used to screen for the production of nitrite (NIT) and leucocyte esterase (LE), following the manufacturer's instructions. Biochemical reactions of nitrite and leucocyte esterase > “trace” were classified as “positive.” A quantitative urine culture was used as the gold standard. Results The highest sensitivity value and negative predictive value were recorded for the combined “NIT+ or LE+” dipstick results. The highest specificity value, positive predictive value, positive likelihood ratio, and negative likelihood ratio were recorded for “nitrite-positive and leucocyte esterase-positive” results. Combined “nitrite-positive or leucocyte-positive” result was relatively the best indicator for accurate dipstick diagnosis, with AUC = 0.7242. Cohen's kappa values between dipstick diagnosis and quantitative culture were <0.6. Conclusion Combined performance of nitrite and leucocyte esterase results appeared better than the solo performance of nitrite and leucocyte esterase. However, little confidence should be placed on dipstick diagnosis; hence, request for quantity culture should be encouraged in the primary healthcare settings.

show abstract

Section: Discussioncontrasting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Dipstick for the Detection of Urinary Tract Infection

Dadzie

Quansah

Dakorah

et al. 2019

Canadian Journal of Infectious Diseases and Medical Microbiolog

View full text Add to dashboard Cite

show abstract

“…Therefore, the presence of nitrites is highly predictive of UTI, but their absence does not exclude it. In a marked contrast, a higher sensitivity of 90% for NIT+ alone, was reported by Sirasaporn et al among 56 spinal code injury patients (SCI) in Thailand [29]. While UTI in the general population is based on symptoms, urinalysis and culture, this approach is not applicable to SCI patients as they already have an impaired neurological function and urinary system[30,31].…”

Section: Discussionmentioning

confidence: 99%

The diagnostic accuracy of the point-of-care urine dipstick test in detecting urinary tract infection among symptomatic patients in Nairobi County, Kenya

Onyango,

Sloan,

Keenan

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Urinary tract infections (UTIs) are among the most frequently diagnosed bacterial infections and constitute a large proportion of workload in clinical microbiology laboratories. Urine culture is the confirmatory test for UTI. However, most primary care settings routinely use the more rapid, less labour-intensive dipstick. This study assesses the characteristics of a urine dipstick test in predicting a positive urine culture and how best it can be used in a resource constrained settings despite its limitations. Method: A cross-sectional study was conducted at two level-V health facilities in Nairobi County, Kenya. Adults and children presenting with clinical symptoms of UTI were enrolled after obtaining written informed consent. Midstream urine samples were collected. Urinary dipstick was used to identify Nitrites (NIT) and leucocyte esterase (LE) production. Urine was cultured on Cystine Lactose Electrolyte Deficient agar, blood agar and MacConkey agar; and incubated at 370C for 24 hours. Urine cultures with bacteria count of ≥104 cfu/ml were classified as “positive” for UTI. Results: Of a total of 552 participants enrolled into the study, 124 (23%) were urine culture positive. Prior medication use was associated with culture negativity. With urine culture as the reference standard, urinary dipstick sensitivity was poor overall (using either LE+ or NIT+ to confer a positive dipstick result still only achieved sensitivity of 66.9%). Using combined NIT+ and LE+ to confer a positive dipstick result had the highest specificity (99.2%), alongside a positive predictive value of 91.1%, and a positive likelihood ratio of 35.6. A NIT+ test alone showed highest concordance with urine culture results (percentage agreement: 86%) but still had a Cohen’s Kappa value of only 0.5, conferring weak agreement overall. Conclusion: Dipstick test is a poor surrogate of urine culture. However, the test may be suitable as a ‘rule-out’ test to exclude UTI, and avoid antibiotic prescription, when both NIT and LE are negative. Although dipstick continues to be in use in resource constrained settings, poor concordance with urine culture results highlights a need for better near patient tests to diagnose UTI and guide antibiotic decision-making.

show abstract

“…Quantitative urine culture, on the other hand, takes more time and effort to finish. For this reason, the use of one (typically dipstick) or very infrequently two of these protocols without quantitative urine culture is frequently relied upon for clinical laboratory diagnosis of UTI in most primary care settings [7,8]. Most of the time, a urine culture is only ordered when a patient has quite severe symptoms or a recurring infection.…”

Section: Introductionmentioning

confidence: 99%

Utilizing Dipsticks to Measure Leukocyte Esterase in Urine to Detect UTIS

Memon,

Jatoi,

Bhutto

et al. 2023

PJMHS

View full text Add to dashboard Cite

Objective: The more expedient, less labor-intensive dipstick has come to be the tool of choice for diagnosing UTIs in the majority of primary care settings. The purpose of this study was to assess the usefulness of dipsticks in UTI diagnosis. Study Design: Descriptive study Place and Duration: Pathology Department Civil Hospital LUMHS. January 2021 to December 2021 Methods: Total 230 patients of both gender were presented in this study. The study included every urine sample that was received for urine culture by the Microbiology Department. The leukocyte esterase content of each specimen was measured using a urine dipstick. On Cysteine Lactose Electrolyte Deficient (CLED) agar, all of the urine samples were also used for culture. Every data was analysed using SPSS 24.0. Results: There were majority 125 (54.3%) females and 105 (45.7%) females among all cases. There were 75 (32.6%) LE positive and 120 (52.2%) were LE negative. Culture positive cases was 87 (37.8%) and 143 (62.2%) were culture negative. We found sensitivity (78.2%), specificity (86%), PPV (55.7%) and NPV (90.4%). The overall effectiveness of the LE Test with dipsticks was observed (84.3%). Conclusion: Under resource-constrained environments, the leukocyte esterase dipstick test is a quick and affordable screening method. Determining whether a urinary tract infection is present is very helpful. A negative test, however, gives a more accurate indication that a UTI is absent. Keywords: Urine culture, Urinary Tract Infection, Leukocyte esterase dipsticks

show abstract

The reliability and validity of using the urine dipstick test by patient self-assessment for urinary tract infection screening in spinal cord injury patients

Cited by 8 publications

References 15 publications

The Effectiveness of Dipstick for the Detection of Urinary Tract Infection

The Effectiveness of Dipstick for the Detection of Urinary Tract Infection

The diagnostic accuracy of the point-of-care urine dipstick test in detecting urinary tract infection among symptomatic patients in Nairobi County, Kenya

Utilizing Dipsticks to Measure Leukocyte Esterase in Urine to Detect UTIS

Contact Info

Product

Resources

About