What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women?

Medina-Bombardó, David; Seguí-Díaz, M; Roca-Fusalba, C; Llobera, Joan

doi:10.1093/fampra/20.2.103

Cited by 40 publications

(39 citation statements)

References 9 publications

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“…An epidemiologic study from Spain involving 343 women aged 14 to 90 years showed that pretest probability of having a UTI among patients with new urinary symptoms was 0.48; positive likelihood ratio (LR) for new dysuria was 1.31 (95% CI, 1.12–1.54), new urgency 1.29 (95% CI, 1.12–1.50), and new urinary frequency 1.16 (95% CI, 1.06–1.28). 35 This study reinforces the notion that new dysuria is the most discriminating clinical finding for symptomatic UTI. When evaluating new dysuria, timing, severity, and location are important.…”

Section: The Evidence: Diagnosis Management and Preventionsupporting

confidence: 88%

Urinary Tract Infections in Older Women

Mody

Juthani‐Mehta

2014

JAMA

279

170

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IMPORTANCE Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. OBJECTIVE To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women. EVIDENCE REVIEW A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. RESULTS The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs. CONCLUSIONS AND RELEVANCE Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.

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Section: The Evidence: Diagnosis Management and Preventionsupporting

confidence: 88%

Urinary Tract Infections in Older Women

Mody

Juthani‐Mehta

2014

JAMA

279

170

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“…Most of these diagnostic indicators have been studied in single-test evaluations, implying that a test is compared with the urine culture without taking into account the results of preceding tests, including clinical history. [16][17][18][19] In clinical practice, however, the diagnostic work-up is multivariable, and test results are mutually dependent. [20][21][22][23][24] For example, the diagnostic value of the dipslide used in isolation may be considerable, but it might not add much once the clinical history and nitrite test result are known.…”

Section: Diagnosing Acu T E Unco Mpl Ic At Ed U T Imentioning

confidence: 99%

Toward A Simple Diagnostic Index for Acute Uncomplicated Urinary Tract Infections

Knottnerus

Geerlings

Charante

et al. 2013

The Annals of Family Medicine

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PURPOSE Whereas a diagnosis of acute uncomplicated urinary tract infection (UTI) in clinical practice comprises a battery of several diagnostic tests, these tests are often studied separately (in isolation from other test results). We wanted to determine the value of history and urine tests for diagnosis of uncomplicated UTIs, taking into account their mutual dependencies and information from preceding tests. METHODSWomen with painful and/or frequent micturition answered questions about their signs and symptoms (history) of UTIs and underwent urine tests. A culture was the reference standard (10 3 colony-forming units per milliliter). A diagnostic index was derived using logistic regression with bootstrapped backward selection and parameter-wise shrinkage. Risk thresholds for UTI of 30% and 70% were used to analyze discriminative properties. Six models were compared: (1) history only, (2) history + urine dipstick, (3) history + urine dipstick + urinary sediment, (4) history + urine dipstick + dipslide, and (5) history + urine dipstick + urinary sediment + dipslide; we then added (6) a test only for patients with an intermediate risk (between 30% and 70%) after the preceding test. RESULTSOne hundred ninety-six women were included (UTI prevalence 61%). Seven variables were selected from history (3), dipstick (2), sediment (1), and dipslide (1). History correctly classified 56% of patients as having a UTI risk of either <30% or >70%. History and urine dipstick raised this to 73%. The 3 models with the addition of urinary sediment and dipslide, separately and in combination, performed hardly better. The sixth model, in which those at intermediate risk after history and received an additional test, correctly classified 83%. The patient's suspicion of a UTI and a positive nitrite test were the strongest indicators of a UTI.CONCLUSIONS Most women with painful and/or frequent micturition can be correctly classified as having either a low or a high risk of UTI by asking 3 questions: Does the patient think she has a UTI? Is there at least considerable pain on micturition? Is there vaginal irritation? Other women require additional urine dipstick investigation. Sediment and dipslide have little added value. External validation of these recommendations is required before they are implemented in practice. INTRODUCTIONA cute uncomplicated urinary tract infections (UTIs) are infections of the lower urinary tract in healthy, nonpregnant, adult women. The diagnosis is made by the presence of urinary symptoms in combination with bacteriuria.1-4 Sixty percent of all women experience at least 1 UTI during their life. 5 The symptoms are bothersome and have a negative impact on quality of life. [6][7][8][9] Although empiric antibiotic treatment of all women with urinary symptoms has been reported to be cost-effective, 10,11 bacterial resistance is rising, [12][13][14][15] and an accurate diagnosis of UTI is needed to facilitate a well-targeted use of antibiotics.Various medical history questions and urine investigations can ...

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“…The second screening (of full-text articles) revealed eight studies [14,18-23,26,28] that satisfied the inclusion criteria. Three additional articles were cited in reviews or in the references of other articles and were subsequently included in our study [24,25,27] (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis

Medina-Bombardó

Jover-Palmer

2011

BMC Fam Pract

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BackgroundClinicians should be aware of the diagnostic values of various symptoms, signs and antecedents. This information is particularly important in primary care settings, where sophisticated diagnostic approaches are not always feasible. The aim of the study is to determine the probability that various symptoms, signs, antecedents and tests predict urinary tract infection (UTI) in women.MethodsWe conducted a systematic search of the MEDLINE and EMBASE databases to identify articles published in all languages through until December 2008. We particularly focused on studies that examined the diagnostic accuracy of at least one symptom, sign or patient antecedent related to the urinary tract. We included studies where urine culture, a gold standard, was preformed by primary care providers on female subjects aged at least 14 years. A meta-analysis of the likelihood ratio was performed to assess variables related to the urinary tract symptoms.ResultsOf the 1, 212 articles identified, 11 met the selection criteria. Dysuria, urgency, nocturia, sexual activity and urgency with dysuria were weak predictors of urinary tract infection, whereas increases in vaginal discharge and suprapubic pain were weak predictors of the absence of infection. Nitrites or leukocytes in the dipstick test are the only findings that clearly favored a diagnosis of UTI.ConclusionsClinical findings do not aid in the diagnosis of UTI among women who present with urinary symptoms. Vaginal discharge is a weak indicator of the absence of infection. The urine dipstick test was the most reliable tool for detecting UTI.

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What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women?

Abstract: In women with urinary symptoms, a thorough clinical examination, together with performance of a reactive strip test during the office visit, improves the chances of detecting UTI.

Cited by 40 publications

References 9 publications

Urinary Tract Infections in Older Women

Urinary Tract Infections in Older Women

Toward A Simple Diagnostic Index for Acute Uncomplicated Urinary Tract Infections

Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis

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