Utility of point-of-care Gram stain by physicians for urinary tract infection in children ≤36 months

Abstract

Urinary tract infection (UTI) in children requires early diagnosis and treatment to prevent repeated UTI and renal scarring. This study aimed to evaluate the usefulness of the point-of-care Gram stain by physicians for suspected UTI in children at Okinawa Chubu Hospital as a rapid diagnostic test. A single-center, retrospective study was undertaken between January 2011 and December 2015. Patients aged 36 months or younger who were reviewed had suspected UTI in the emergency room or outpatient clinic. Urine culture, urinalysis, and point-of-care Gram stain were performed on a single specimen. Patients with structural or functional urological defects requiring routine catheterization were excluded. We compared the diagnostic performance among the rapid diagnostic tests (i.e., pyuria, point-of-care Gram stain, or both). Kappa statistics were used to evaluate the agreement between the results of point-of-care Gram stain and morphotypes of urine culture with the 95% CI (bias corrected bootstrap interval). We also analyzed which antibiotics were more susceptible to the bacteria of urine culture results, selected by the results of point-of-care Gram stain or empirical treatment based on the Japanese guidelines by McNemar test. Of 1594 patients reviewed in the study, 1546 were eligible according to our inclusion criteria. Using urine culture as the gold standard for UTI, the sensitivity and specificity of pyuria were 73.2% and 95.1%, whereas those of the point-of-care Gram stain were 81.4% and 98.2%, respectively. The concordance rate between the morphotypes of bacteria detected by point-of-care Gram stain and those of urine culture was 0.784 (kappa coefficient) (95% CI 0.736–0.831). Furthermore, the proportion of “susceptible” in the minimum inhibitory concentration of pathogen-targeted treatment based on the point-of-care Gram stain was higher than that of empirical therapy (exact McNemar significance probability: .0001). Our analysis suggests that the point-of-care Gram stain is a useful rapid diagnostic tool for suspected UTI in young children. Pathogen-targeted treatment based on the point-of-care Gram stain would lead to better antibiotic selection compared with empirical therapy.

Unmet need of antenatal screening for asymptomatic bacteriuria: A risk factor for adverse outcomes of pregnancy

“…Seventy-eight records were retrieved from the electronic database, while 25 studies[13141516171819202122232425262728293031323334353637] were retained for qualitative synthesis [Figure 1]. The researchers had studied 11 individual tests and 7 combinations of various tests [Figure 1].…”

Point-of-care cerebrospinal fluid Gram stain for the management of acute meningitis in adults: a retrospective observational study

“…At most other hospitals, clinicians are unfamiliar with PCGS and lack the experience required to read Gram stain results [11]. Fourth, quality control of PCGS was not assessed in this study, although PCGS is the standard of care at Okinawa Chubu Hospital and its quality has been confirmed in several other studies [18,27,28]. Fifth, our ability to confirm the etiologies of aseptic meningitis was limited because further examinations other than those on the commercial level were not performed.…”

“…Accurate interpretation of CSF Gram stain results largely depends on the expertise of the individual performing the test [ 26 ]. PCGS can be interpreted with high accuracy by doctors who are experienced at performing and reading Gram stains, as studies on respiratory and urinary tract infections have shown [ 18 , 27 , 28 ]. At Okinawa Chubu Hospital, trainee doctors are still taught to consider Gram stain as part of a normal physical examination, as doctors in the United States used to be [ 23 , 29 , 30 ].…”

Point-of-care Cerebrospinal Fluid Gram Stain For the Management of Acute Meningitis in Adults: A Retrospective Observational Study

“…Accurate interpretation of CSF Gram stain results largely depends on the expertise of the individual performing the test [26]. PCGS can be interpreted with high accuracy by doctors who are experienced at performing and reading Gram stains, as studies on respiratory and urinary tract infections have shown [27,18,28]. At Okinawa Chubu Hospital, trainee doctors are still taught to consider Gram staining as part of a normal physical examination, as doctors in the United States used to be [23,29,30].…”

“…At most other hospitals, clinicians are unfamiliar with PCGS and lack the experience required to read Gram stain results [11]. Fourth, quality control of PCGS was not assessed in this study, although PCGS is the standard of care at Okinawa Chubu Hospital and its quality has been con rmed in several other studies [18,28,27]. Fifth, our ability to con rm the etiologies of aseptic meningitis was limited because further examinations other than those on the commercial level were not performed.…”