Urinalysis and Urinary Tract Infection: Update for Clinicians

Young, Jennifer L.; Soper, David E.

doi:10.1155/s1064744901000412

Cited by 25 publications

(25 citation statements)

References 35 publications

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“…Similar findings have been reported by others as well (3,20). In our study, absence of pyuria emerged as best predictor for 'ruling out' UTI even if the woman had symptoms (Se 93.70%, NPV 91.84%, AUC 77.07%, LR) 0.1) as also mentioned in some of the earlier reports (8,9). Symptoms of urgency, burning during micturition and pyuria were further analysed by logistic regression model.…”

Section: Discussionsupporting

confidence: 90%

“…Pyuria is reported to be the single best indicator of bacteriuria in patients, corresponding with active infection of the urinary tract (9,10). Testing for pyuria can be advocated as a ‘near patient test’ and can be especially useful for low resource setting without adding much to the patient care cost.…”

Section: Introductionmentioning

confidence: 99%

“…Pyuria is reported to be the single best indicator of bacteriuria in patients, corresponding with active infection of the urinary tract (9,10). Testing for pyuria can be advocated as a 'near patient test' and S U M M A R Y Background: Current clinical guidelines for the management of symptoms suggesting urinary tract infection recommend empiric antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics?

Mishra

Srivastava

Singh

et al. 2012

International Journal of Clinical Practice

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

“…Pyuria is reported to be the single best indicator of bacteriuria in patients, corresponding with active infection of the urinary tract (9,10). Testing for pyuria can be advocated as a 'near patient test' and S U M M A R Y Background: Current clinical guidelines for the management of symptoms suggesting urinary tract infection recommend empiric antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics?

Mishra

Srivastava

Singh

et al. 2012

International Journal of Clinical Practice

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“…In uncomplicated UTI, the presence of nitrites and leukocyte esterase by urine dipstick may obviate the need for urine culture [14]. This was not looked at in this study because all urine specimens were sent to the laboratory for analysis and culture.…”

Section: Discussionmentioning

confidence: 99%

There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis patients followed longitudinally

Stanford

McMurphy

2006

Int Urogynecol J

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The objective of this paper was to establish whether patients with confirmed painful bladder syndrome/interstitial cystitis (PBS/IC) presenting with symptoms of UTI have actual bacteriuria vs a flare of their PBS/IC symptoms. One hundred and six (n = 106) consecutive female patients (mean age 39.8 +/- 14 years) with newly diagnosed IC were identified and followed longitudinally for 24 months. At the initial visit and at all subsequent visits, urinary specimens were obtained by sterile catheterization (Bard 14Fr female) and cultured for bacteria. Eight patients had an initially positive urine culture, and repeat cultures 8 weeks after treatment were all negative. Once sterile urine was established, the diagnosis of PBS/IC was confirmed. A pelvic pain/urgency/frequency (PUF) questionnaire score was obtained from 89 patients. After the diagnosis of PBS/IC, all patients received multimodal treatment. Patients were instructed to present to the office whenever they developed symptoms of UTI, at which time a sterile catheter specimen was obtained and sent for culture. Greater than 10(3) colonies were considered positive. Patients who did not report flares were contacted to establish whether unreported treatments were given. Seventy-two patients (68%) had no UTI episodes or flares. The remaining 34 patients (32%) presented with 54 flares, of which 44 were culture-negative and 10 were culture-positive. A single flare was reported by 21 patients during the 24 months, with three positive cultures (14.3%). Recurrent UTI symptoms (two to four flares) were seen in a small group (n = 13) for a total of 33 flares. Of these, seven had two flares each (12 negative, 2 positive), five had three flares each (12 negative, 3 positive), and one patient had four flares (two negative, two positive). Therefore, within the group with recurrent symptoms, seven positive cultures were obtained for a rate of recurrent bacteriuria of 6.6% (7/106). Nine of the 10 positive bacterial cultures were due to gram-negative bacteria: Escherichia coli (n = 6), Proteus mirabilis (n = 1), Klebsiella pneumonia (n = 1), and Citrobacter sp. (n = 1). One grew Streptococcus sp. There was no difference between the flare group and nonflares in regards to age or PUF scores between groups. This study is the first to report on the low incidence of confirmed UTIs in a large group of PBS/IC patients followed longitudinally. These data suggest that only a small number of PBS/IC patients with UTI symptoms have positive urine cultures (9.4%; 10/106). Although the symptoms of recurrent UTI are prevalent in IC patients, the incidence of confirmed recurrent UTIs is only 6.6%. Because the flares of IC are usually self-limiting, treatment response to antibiotics may be misleading in light of the low incidence of positive urine cultures. These data suggest that the symptom flares of IC are not usually associated with recurrent UTI and, therefore, are likely due to a triggering of the other painful mechanisms involved in IC patients who are culture-negative.

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“…In otherwise healthy women, urine nitrites and leukocyte esterase (LE) suggest the presence of nitrite producing bacteria and leukocytes, respectively, in the urinary tract. Urine nitrites have a reported sensitivity of 46–71% and specificity of 82–98% depending on the population and clinical setting [7–10]. LE can be used to identify nitrite-negative UTIs and other inflammatory processes [11] and, by comparison, LE tends to have a higher sensitivity (62–86%) and more variable specificity (70–93%) than nitrites [7, 9].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Role of Urinalysis for Suspected Cystitis in Women Undergoing Pelvic Radiotherapy

Ol³

et al. 2016

International Journal of Gynecological Cancer

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Purpose To analyze the effectiveness of urinalysis parameters in predicting positive urine culture and to characterize urinary tract infections (UTIs) in gynecologic cancer patients receiving pelvic radiotherapy. Materials and Methods The records of 134 women receiving pelvic radiotherapy were retrospectively analyzed with a total of 241 urine specimens. Dipstick, urine microscopy, and urine culture data were recorded. Sensitivities, specificities, positive and negative predictive values (PPV and NPV), and diagnostic odds ratios (DOR) of dipstick and microscopy components for predicting positive urine culture were calculated. Organisms isolated from positive cultures and their antibiotic resistance data were recorded. Results A total of 84 (34.9%) urine cultures were positive for growth. The presence of either urine nitrites, leukocyte esterase (LE), or both had the highest sensitivity (91.7%) of all tested parameters for predicting a positive urine culture. The presence of both urine white blood cells (WBC) and urine nitrites had the highest specificity (95.5%), PPV (75.0%) and DOR (7.21 [2.92 – 17.83]) whereas the absence of urine WBCs had the highest NPV (87.0%). Escherichia coli was the most common grown in culture, isolated from 19 (22.6%) of specimens. When antibiotic sensitivity analysis was performed, 23.8% of pathogens were resistant to trimethoprim/sulfamethoxazole, 16.7% were resistant to ciprofloxacin, and 11.1% were resistant to nitrofurantoin. Conclusions UA may be less accurate for predicting UTI in women undergoing pelvic RT compared to the general population, but is still useful. Escherichia coli was less common than expected and the rate of resistance to first-line antibiotics was relatively high, underscoring the importance of culture and sensitivity testing in order to confirm the efficacy of empiric antibiotic therapy.

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Urinalysis and Urinary Tract Infection: Update for Clinicians

Cited by 25 publications

References 35 publications

Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics?

Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics?

There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis patients followed longitudinally

Evaluating the Role of Urinalysis for Suspected Cystitis in Women Undergoing Pelvic Radiotherapy

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