Dipstick urinalysis and the accuracy of the clinical diagnosis of urinary tract infection

The aim of this study was to determine whether dipstick urinalysis (DU) augmented the accuracy of clinical assessment in the diagnosis of urinary tract infection (UTI). The study was performed in 627 consecutive patients attending an adult emergency department (ED) in whom the clinical diagnosis of UTI was considered. We excluded 227 patients. Treating clinicians gave the probability of a UTI on an ordinal and continuous scale, before and after DU. The assigned clinical probabilities were then compared to the results of formal urine culture. The areas under receiver-operating characteristic curves (AUC) were calculated. We found that clinical assessment alone was effective in detecting those patients with a UTI from those without (AUC 0.75; p < 0.0001). There was, however, a statistically significant difference in the accuracy of diagnosing UTI after DU (AUC 0.87; p < 0.0001). Proportionately more patients with a moderate pre-test probability of UTI were re-assigned to a different probability rating following DU, compared to the low or high pre-test probability groups (p < 0.001). We conclude that DU in combination with clinical assessment is a superior method for diagnosing UTI than clinical assessment alone.     

Multistix versus laboratory urinalysis in the detection of urinary tract infection.

1. Difficulty with the early recognition of infection is a problem when caring for patients in an extended care facility. 2. The ability to quickly differentiate between asymptomatic bacteriuria and actual infection in male extended care patients is useful for guiding antibiotic therapy. 3. The nurse-administered nitrite test proved reliable as an indicator or urinary tract infection.     

Validity of urinalysis and microscopy for detecting urinary tract infection in the emergency department.

This study assessed the validity of standard urinalysis, urinalysis for leucocyte esterase and nitrites, and urgent microscopy in the diagnosis of urinary tract infection (UTI) in 60 female patients with a triage diagnosis of UTI. There were 24 (40%) proven UTIs after culture. Simple urinalysis was sensitive for UTI (95.8%) but the positive predictive value was only 45.1%. The addition of leucocyte esterase and nitrite urinalysis testing did not improve the sensitivity, but if both of these were positive the positive predictive value improved to 100%. Urgent microscopy alone was sensitive (100%) but non-specific (38.9%). The specificity of the diagnosis improved to 94.4% for organism counts of >or=10/microl and to 88.9% for leucocyte counts of >or=50/microl. The negative predictive value of no detectable leucocytes on microscopy was 94.7%. Screening for UTI in the emergency department (ED) population is improved by the addition of leucocyte esterase and nitrite test. A positive urinalysis test for leucocytes and nitrites, or urinalysis positive at levels of >or=500 leucocytes or >or=5 g/l protein should confirm a clinical diagnosis of UTI. Urgent urine microscopy should be performed only if the above criteria are not met yet a minimum of one urinalysis result is positive.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

Performance characteristics of urinalyses for the diagnosis of pediatric urinary tract infection

Purpose

The purpose of this study is to determine whether point-of-care (POCT) urinalysis (UA) is as accurate as laboratory-performed UA in diagnosing urinary tract infections (UTIs) in the pediatric emergency department (PED).

Basic procedures

This was a retrospective series of children (0-18 years old) seen at a tertiary care PED from July 2008 to December 2012 in whom UA and urine culture were obtained. Urinalyses were considered positive if leukocyte esterase and/or nitrites were positive. Performance characteristics for the 2 types of UAs were calculated using urine culture as the reference standard.

Main findings

A total of 43 452 specimens were sent for laboratory-performed UA and culture, and 6492, for POCT UA and culture (in 2908 specimens, both UAs were performed). Sixty-four percent of specimens were from girls, 51% were catheterized, and 7.5% had UTIs. The sensitivity of POCT UAs and laboratory-performed UAs was 82.5% (confidence interval [CI], 79.4%-85.3%) and 89.1% (CI, 86.4%-88.8%), respectively. The superior performance of laboratory-performed UAs was driven by the sensitivity of microscopy. Laboratory-performed UAs were more sensitive than the POCT in girls (90.6% [CI, 89.4%-91.8%] vs 82.8% [79.4%-85.8%]).

Principal conclusions

Although POCT UAs offer more rapid turnaround times, the sensitivity is greater for laboratory-performed UAs. Given the difficulty in following up PED patients after discharge as well as the potential morbidity from untreated UTIs, the rapidity of the POCT UA must be balanced against the lower sensitivity of this assay. The benefit of more accurate diagnosis may outweigh the potentially longer PED length of stay associated with a laboratory-performed UA.     

Development of a score based on urinalysis to improve the management of urinary tract infection in children

BackgroundThe need for reducing unnecessary antibiotic treatment is being emphasized in the management of urinary tract infections (UTI), a disease frequent in childhood. An ideal test should provide early diagnosis without the waiting times of urine culture, but even a simple test of exclusion could significantly improve patient management.MethodsWe evaluated the sensitivity, specificity, negative and positive predictive value of automated microscopy IRIS iQ200 combined with the dipstick analyses in children with suspected UTI. Multivariable logistic regression analysis was used to identify the set of variables that best predict positive culture results and develop a numerical risk score.ResultsOf 474 consecutive urine samples retrospectively analyzed, 69 were positive at urine culture with prevalence of infection of 14.6%. Parameters significantly associated with the presence of infection in multivariable analysis were age < 1 year (p < 0.001), leukocyte esterase ≥ 15 × 10^6/L (p < 0.001), number of small particles (ASP) ≥ 5500 × 10^6/L (p < 0.001) and bacteria ≥ 3 × 10^6/L (p = 0.01). The derived score ranged from 0 to 10, with higher values indicating higher risk of UTI. The area under the score ROC curve was 79% (95% CI 0.72–0.85), and was better than those of the individual urinary chemical and microscopic analyses.ConclusionsThis routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for whom antibiotic treatment can be withheld until the results of urine culture become available.     

尿沉渣革兰染色直接镜检诊断泌尿系感染的价值

泌尿系感染是常见病,发病率约为2％。多种微生物可引起泌尿系感染,如细菌、真菌、衣原体、支原体和某些病毒等。笔者采用革兰染色显微镜直接镜检,对细菌引起的泌尿系感染进行初步诊断,现报道如下。