Use of the leukocyte esterase and nitrite tests to determine the need for culturing urine specimens from a pediatric and adolescent population

Marsik, Frederic J.; Owens, Dana; Lewandowski, Jeanine

doi:10.1016/0732-8893(86)90155-0

“…Some investigators have demonstrated a cost savings by using the Chemstrip LN to determine the need for culturing urine specimens (5,49,56). With this approach, Marsik and associates evaluated urine specimens from pediatric and adolescent patients and estimated a $5,000/year savings to the laboratory and a $10,000/year savings to the patient (56).…”

Section: Laboratory Approach To Screeningmentioning

confidence: 99%

“…74 (100) 100 (100) 287 (92) 235 (98) Pyuria determination LE 84 (84) 199 (83) Hemacytometer 54 (73) 95 (95) 250 (80) 172 (72) Pyuria-guided SC LE 56 (56) 240 (100) Hemacytometer 36 (49) 60 (60) 313 (100) 240 (100) Pyuria-guided DPM/LCC LE 84 (84) 239 (99) Hemacytometer 54 (73) 95 (95) 307 (98) 238 (99) Pyuria-guided DPM/LCC or SC without pyuria LE 92 (92) 239 (99) Hemacytometer 68 (92) 99 (99) 307 (98) 238 (99) " Percentages are given in parentheses.…”

Section: Laboratory Approach To Screeningmentioning

confidence: 99%

Detection of urinary tract infections by rapid methods

Pezzlo

¹

1988

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A review of rapid urine screens for detection of bacteriuria and pyuria demonstrates a number of available alternatives to the culture method. Selection of one or more of these systems for routine use is dependent upon the laboratory and the patient population being tested. The laboratory approach to the diagnosis of urinary tract infection should consider the clinical diagnosis of the patient whenever possible. Keeping in mind that quantitative urine cultures alone cannot be used to detect infection in some patient populations unless lower colony counts are considered, a rapid screen may be a more practical approach. It has become accepted that 10(5) CFU/ml can no longer be used as the standard for all patient groups, that pyuria often is important in making the diagnosis of a urinary tract infection, and that most of the rapid screens are more sensitive than the culture method at 10(5) CFU/ml. Presently, no one approach can be recommended for all laboratories and all patient groups. However, each diagnostic laboratory should select one approach which is best for its situation. It is not practical, efficient, or cost effective to define a protocol for each possible clinical condition; however, all should be considered when developing a protocol. This protocol should be compatible with the patient population and communicated to the physicians. Use of a rapid screen should be beneficial to the patient, the physician, and the laboratory.

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“…12 Previous studies have questioned the additional benefit of microscopy over dipstick urinalysis in children; however, these studies included few infants 1 to 90 days of age. [14][15][16][17][18][19][20] Although dipstick is rapid, inexpensive, and does not require special training, there currently are insufficient data to recommend dipstick urinalysis alone as a screen for UTI in febrile infants.Providers within Intermountain Healthcare use an evidence-based care process model (EB-CPM) for management of the febrile infant aged 1 to 90 days. 3 The EB-CPM currently recommends urethral catheterization for dipstick urinalysis in combination with microscopy of centrifuged urine (here termed "combined urinalysis") to screen for UTI while urine culture is pending.…”

mentioning

confidence: 99%

“…12 Previous studies have questioned the additional benefit of microscopy over dipstick urinalysis in children; however, these studies included few infants 1 to 90 days of age. [14][15][16][17][18][19][20] Although dipstick is rapid, inexpensive, and does not require special training, there currently are insufficient data to recommend dipstick urinalysis alone as a screen for UTI in febrile infants.…”

mentioning

confidence: 99%

Dipstick Screening for Urinary Tract Infection in Febrile Infants

Glissmeyer¹,

Korgenski

²

,

Wilkes

³

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Urinary tract infection (UTI) is the most common bacterial infection in febrile infants aged 1 to 90 days. It is unclear if urine microscopy offers significant benefit beyond urine dipstick as a screening test for UTI in this population.WHAT THIS STUDY ADDS: Dipstick may be an adequate screening test for UTI in infants aged 1 to 90 days with a negative predictive value (NPV) of 98.7%. Adding microscopy increases the NPV to 99.2% but results in 8 false-positives for every UTI missed by dipstick.abstract OBJECTIVE: This study compares the performance of urine dipstick alone with urine microscopy and with both tests combined as a screen for urinary tract infection (UTI) in febrile infants aged 1 to 90 days. METHODS:We queried the Intermountain Healthcare data warehouse to identify febrile infants with urine dipstick, microscopy, and culture performed between 2004 and 2011. UTI was defined as .50 000 colonyforming units per milliliter of a urinary pathogen. We compared the performance of urine dipstick with unstained microscopy or both tests combined ("combined urinalysis") to identify UTI in infants aged 1 to 90 days. RESULTS:Of 13 030 febrile infants identified, 6394 (49%) had all tests performed and were included in the analysis. Of these, 770 (12%) had UTI. Urine culture results were positive within 24 hours in 83% of UTIs. The negative predictive value (NPV) was .98% for all tests. The combined urinalysis NPV was 99.2% (95% confidence interval: 99.1%-99.3%) and was significantly greater than the dipstick NPV of 98.7% (98.6%-98.8%). The dipstick positive predictive value was significantly greater than combined urinalysis (66.8% [66.2%-67.4%] vs 51.2% [50.6%-51.8%]). These data suggest 8 febrile infants would be predicted to have a false-positive combined urinalysis for every 1 infant with UTI initially missed by dipstick screening.CONCLUSIONS: Urine dipstick testing compares favorably with both microscopy and combined urinalysis in febrile infants aged 1 to 90 days. The urine dipstick test may be an adequate stand-alone screen for UTI in febrile infants while awaiting urine culture results. Pediatrics 2014;133:e1121-e1127 UTI screening methods may include dipstick urinalysis and/or microscopy of centrifuged urine, as well as other methods. 3,4,[9][10][11] Urine dipstick is an inexpensive and rapid screening test that can be performed in office settings and other laboratories and is waived by the Clinical Laboratory Improvement Amendment (CLIA). 12 Dipstick has been shown to perform well in children $2 years old as a screening test for UTI. 13 Microscopic examination of urine requires technicians with special training in laboratories using CLIA-certified methods. 12 Previous studies have questioned the additional benefit of microscopy over dipstick urinalysis in children; however, these studies included few infants 1 to 90 days of age. [14][15][16][17][18][19][20] Although dipstick is rapid, inexpensive, and does not require special training, there currently are insufficient data t...

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“…12 Previous studies have questioned the additional benefit of microscopy over dipstick urinalysis in children; however, these studies included few infants 1 to 90 days of age. [14][15][16][17][18][19][20] Although dipstick is rapid, inexpensive, and does not require special training, there currently are insufficient data to recommend dipstick urinalysis alone as a screen for UTI in febrile infants.…”

mentioning

confidence: 99%

Dipstick Screening for Urinary Tract Infection in Febrile Infants

2014

PEDIATRICS

0

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WHAT'S KNOWN ON THIS SUBJECT: Urinary tract infection (UTI) is the most common bacterial infection in febrile infants aged 1 to 90 days. It is unclear if urine microscopy offers significant benefit beyond urine dipstick as a screening test for UTI in this population.WHAT THIS STUDY ADDS: Dipstick may be an adequate screening test for UTI in infants aged 1 to 90 days with a negative predictive value (NPV) of 98.7%. Adding microscopy increases the NPV to 99.2% but results in 8 false-positives for every UTI missed by dipstick.abstract OBJECTIVE: This study compares the performance of urine dipstick alone with urine microscopy and with both tests combined as a screen for urinary tract infection (UTI) in febrile infants aged 1 to 90 days. METHODS:We queried the Intermountain Healthcare data warehouse to identify febrile infants with urine dipstick, microscopy, and culture performed between 2004 and 2011. UTI was defined as .50 000 colonyforming units per milliliter of a urinary pathogen. We compared the performance of urine dipstick with unstained microscopy or both tests combined ("combined urinalysis") to identify UTI in infants aged 1 to 90 days. RESULTS:Of 13 030 febrile infants identified, 6394 (49%) had all tests performed and were included in the analysis. Of these, 770 (12%) had UTI. Urine culture results were positive within 24 hours in 83% of UTIs. The negative predictive value (NPV) was .98% for all tests. The combined urinalysis NPV was 99.2% (95% confidence interval: 99.1%-99.3%) and was significantly greater than the dipstick NPV of 98.7% (98.6%-98.8%). The dipstick positive predictive value was significantly greater than combined urinalysis (66.8% [66.2%-67.4%] vs 51.2% [50.6%-51.8%]). These data suggest 8 febrile infants would be predicted to have a false-positive combined urinalysis for every 1 infant with UTI initially missed by dipstick screening.CONCLUSIONS: Urine dipstick testing compares favorably with both microscopy and combined urinalysis in febrile infants aged 1 to 90 days. The urine dipstick test may be an adequate stand-alone screen for UTI in febrile infants while awaiting urine culture results.

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Use of the leukocyte esterase and nitrite tests to determine the need for culturing urine specimens from a pediatric and adolescent population

Cited by 25 publications

References 5 publications

Detection of urinary tract infections by rapid methods

Detection of urinary tract infections by rapid methods

Dipstick Screening for Urinary Tract Infection in Febrile Infants

Dipstick Screening for Urinary Tract Infection in Febrile Infants

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