The Sensitivity and Specificity of White Blood Cells and Nitrite in Dipstick Urinalysis in Association With Urine Culture in Detecting Infection in Adults From October 2016 to October 2019 at King Abdulaziz Medical City

Mohanna, Abdulrahman T; Alshamrani, Khalid M; SaemAldahar, Majd A; Kidwai, Abdulbari O; Kaneetah, Abdulrahman H; Khan, Mohammed Anwar; Mazraani, Nadia

doi:10.7759/cureus.15436

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…[ 16 ] and 62.7 % by Mohanna et al . [ 17 ] were all higher than the nitrite test, which is similar to the present study [ 15–17 ]. Most infections elicit an immune response and production of WBCs, which could explain why leucocyte esterase was a better UTI predictor.…”

Section: Discussionsupporting

confidence: 91%

“…Often, the L.E test has a better sensitivity than the nitrite test. The L.E sensitivity of 57.6 % reported by Prah et al [15], 92 % by Suresh et al [16] and 62.7 % by Mohanna et al [17] were all higher than the nitrite test, which is similar to the present study [15][16][17]. Most infections elicit an immune response and production of WBCs, which could explain why leucocyte esterase was a better UTI predictor.…”

Section: Discussionsupporting

confidence: 87%

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Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Maina

Mwaniki

Mwiti

et al. 2023

Access Microbiology

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Introduction. Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. Research gap. In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials. Aim. The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals. Methods. A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard. Results. The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test’s sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %). Conclusion. Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test’s sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Maina

Mwaniki

Mwiti

et al. 2023

Access Microbiology

View full text Add to dashboard Cite

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“…As culture analysis can take several days to yield findings, there may be other viable methods for identifying urinary tract infections in ED settings [ 12 ]. Consequently, rapid and accurate diagnostic techniques with high sensitivity and specificity, such as urine dipsticks or urinalysis, can be beneficial in ED settings for detecting patients with suspected UTIs [ 13 , 14 ]. These tests can provide rapid answers and aid doctors in making prompt decisions on patient care and treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Urine Dipstick and Microscopic Examination Urinalysis With Urine Culture to Evaluate the Sensitivity and Specificity for Each in Diagnosing Urinary Tract Infection in Qassim Region, Saudi Arabia

Almuhanna,

Alhojelan,

Al Rusayni

et al. 2024

Cureus

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Background: Urinalysis is the most popular test for evaluating emergency room patients with possible urinary tract infections (UTIs). Due to their speed and inexpensive cost, urine dipsticks are frequently performed in the Emergency Room. Although a urine dipstick test may be less expensive and time-saving than a laboratory study, it may not be accurate. The study evaluated the sensitivity and specificity of urine dipstick and microscopic urinalysis with a urine culture. Methodology: A prospective, observational study was conducted on adults who visited the Emergency Department at King Fahd Specialist Hospital in Buraydah and reported having dysuria, urine urgency, or frequency, as well as suprapubic or costovertebral angle soreness. Patients who could not give a trustworthy history, had symptoms of vaginal discharge, or had taken antibiotics within the previous 72 hours were excluded. Results: One hundred fifty-three urine samples were collected and examined using urinalysis and dipstick. In addition, 113 (73.86%) of 153 urine samples exhibited no growth in urine culture. With a count of nine, Escherichia coli ( E. coli ) was the most often isolated organism among the positive cultures (5.88%). Klebsiella pneumoniae was the second most common in our sample with eight (5.23%). The urine dipstick was shown to have an overall sensitivity of 0.79, specificity of 0.39, positive productive value (PPV) of 0.30, and negative productive value (NPV) of 0.85. Urinalysis exhibited a high sensitivity of 0.95 and a poor specificity of 0.21. Conclusion: Our study showed that urine dipsticks may be more beneficial than urinalysis for ruling out urinary tract infections (UTIs), while urinalysis may be more helpful in verifying their presence.

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“…Moreover, we found a low percentage of positivity in urine cultures. This could be explained by an inadequate handling of the samples, an initiation of antibiotic therapy prior to taking the samples due to self-medication by the patients, or a deficient selection of the samples that require a microbiological study, since it has been demonstrated that a positive result for leukocytes in the test strip as a predictor of bacterial growth has a lower performance than the bacterial count [ 53 , 54 ]. In addition, urine cultures were positive based on the commonly used threshold of >100,000 CFU/ml.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador

Sánchez,

Latacunga,

Cárdenas

et al. 2023

PLoS ONE

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Background Urinary tract infections (UTI) are among the most common cause to prescribe antibiotics in primary care. Diagnosis is based on the presence of clinical symptoms in combination with the results of laboratory tests. Antibiotic therapy is the primary approach to the treatment of UTIs; however, some studies indicate that therapeutics in UTIs may be suboptimal, potentially leading to therapeutic failure and increased bacterial resistance. Methods This study aimed to analyze the antibiotic prescription patterns in adult patients with suspected UTIs and to evaluate the appropriateness of the antibiotic prescription. This is a cross-sectional study of patients treated in outpatient centers and in a second-level hospital of the Ministry of Public Health (MOPH) in a city in Ecuador during 2019. The International Classification of Disease Tenth Revision (ICD-10) was used for the selection of the acute UTI cases. The patients included in this study were those treated by family, emergency, and internal medicine physicians. Results We included a total of 507 patients in the analysis and 502 were prescribed antibiotics at first contact, constituting an immediate antibiotic prescription rate of 99.01%. Appropriate criteria for antibiotic prescription were met in 284 patients, representing an appropriate prescription rate of 56.02%. Less than 10% of patients with UTI had a urine culture. The most frequently prescribed antibiotics were alternative antibiotics (also known as second-line antibiotics), such as ciprofloxacin (50.39%) and cephalexin (23.55%). Factors associated with inappropriate antibiotic prescribing for UTIs were physician age over forty years, OR: 2.87 (95% CI, 1.65–5.12) p<0.0001, medical care by a general practitioner, OR: 1.89 (95% CI, 1.20–2.99) p = 0.006, not using point-of-care testing, OR: 1.96 (95% CI, 1.23–3.15) p = 0.005, and care at the first level of health, OR: 15.72 (95% CI, 8.57–30.88) p<0.0001. Conclusions The results of our study indicate an appropriate prescription rate of 56.02%. Recommended antibiotics such as nitrofurantoin and fosfomycin for UTIs are underutilized. The odds for inappropriate antibiotic prescription were 15.72 times higher at the first level of care compared to the second. Effective strategies are needed to improve the diagnosis and treatment of UTIs.

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The Sensitivity and Specificity of White Blood Cells and Nitrite in Dipstick Urinalysis in Association With Urine Culture in Detecting Infection in Adults From October 2016 to October 2019 at King Abdulaziz Medical City

Cited by 7 publications

References 14 publications

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Comparison Between Urine Dipstick and Microscopic Examination Urinalysis With Urine Culture to Evaluate the Sensitivity and Specificity for Each in Diagnosing Urinary Tract Infection in Qassim Region, Saudi Arabia

Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador

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