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Introduction: Urinary tract infections are the most common bacterial infections in pregnancy.Asymptomatic bacteriuria (ASB) refers to the presence of bacteria in the urine of an individualwithout symptoms of urinary tract infection. ASB which occurs in 2-11% of pregnancies is a majorpredisposition to the development of pyelonephritis. Aims and objectives: The aims and objectivesof the study were to: Study the effectiveness of various screening tests: urine microscopy, gramstain, catalase test, leukocyte esterase test and nitrite test and to compare their sensitivity,specificity, positive predictive value and negative predictive value. Materials and Methods: Thestudy included 500 pregnant women attending the outpatient department over 18 months. The urinesamples collected in sterile containers were screened for urine microscopy, gram stain, catalase test,leukocyte esterase test and nitrite test. The samples were processed on CLED (Cysteine lactoseelectrolyte deficient) agar as the standard against which other screening tests are identified.Results: Gram’s stain (89.34%) was the most sensitive of all and the least reliable test was thecatalase test among the methods of screening tests. Conclusion: Urine culture is considered to bethe gold standard in detecting ASB in pregnant women. Gram’s stain of urine is a good screeningtest when compared to other screening methods. Screening for bacteria in all trimesters isnecessary to prevent the dangerous complications associated with ASB.

Asymptomatic bacteriuria leading to urinary tract infection is the most frequently encountered condition in pregnancy, which has been associated with an increased risk of pre-term delivery and low birth weight. Clinically the diagnosis of UTI can be difficult as symptoms are non-specific. Gold standard method for diagnosis of UTI is urine culture. Up to 18 hours are required for bacterial growth on culture media by standard laboratory techniques, which leads to delay in the treatment. In the present study 100 midstream urine samples from asymptomatic pregnant women were collected. Gram staining, Griess Nitrite Test, Triphenyl tetrazolium chloride test (TTC), Catalase test, these four screening tests were performed on the samples and their results were compared with the results of urine culture. Among these 100 samples, the study revealed that 14 pregnant women had significant bacteriuria (1,00,000 or more bacteria/ ml of urine) giving a prevalence of 14%. This study showed that Gram staining has highest sensitivity i.e. 92.85% and TTC has highest specificity i.e. 98.83% for the detection of significant bacteriuria. To conclude if we perform these two tests in combination then we get a sensitivity of 98.97% and specificity of 94.22% which is not 100% but very close to it. Use of these screening tests will help in early diagnosis and initiation of treatment of UTI in pregnant women. Keywords: Asymptomatic bacteriuria, Pregnancy, Screening tests, UTI.

Introduction: Urinary Tract Infection (UTI) is one of the most common bacterial infection encountered in clinical practice. Even though urine culture is considered as the gold standard in detection of bacteriuria, many alternative screening methods like urine microscopy, chemical analysis using dipstick method and Gram’s staining have been evaluated which are more economical and rapid. Hence, this study was undertaken to evaluate various screening methods in the rapid diagnosis of Urinary Tract Infections. Objectives: To evaluate Gram staining of urine, leucocyte esterase and nitrite dipstick test methods in the rapid diagnosis of Urinary Tract Infections. Materials and Methods: All urine samples received at Microbiology laboratory, McGann hospital, attached to Shimoga Institute of Medical Sciences, during study period was subjected to Gram staining, leucocyte esterase and nitrite dip stick test along with culture. Results of these tests were compared to culture results. Sensitivity and specificity of the tests was determined taking culture as standard. Results: A total of 560 urine samples were processed. Culture showed significant bacteriuria in 210 cases. The sensitivity of urine microscopy was 70.9%, leucocyte esterase test was 98% and nitrite test was 74.8%. Whereas the specificity of urine microscopy was 70%, leucocyte esterase test was 79.1% and nitrite test was 98.8%. Similarly, the sensitivity of combined leucocyte esterase and nitrite tests was 90.9% and specifity was 97.4%. Sensitivity and specificity of all the three screening tests combined were 95.7% and 94.8% respectively. Conclusion: Screening tests such as, Urine microscopy by Gram’s staining, Leucocyte esterase and nitrite dipstick test in combination can be used routinely to exclude bacteriuria. Urine culture can be employed only in the screening tests positive cases and in symptomatic cases irrespective of test results, thereby making diagnosis of UTI cost effective and rapid. Keywords: Bact

Objective: The purpose of this study is to evaluate the diagnostic value of nitrite test in comparison with urine culture (U/C) results in patients with Urinary tract infection (UTI) symptoms. Methods: This cross-sectional study was performed on 203 patients with UTI symptoms. Middle urine sample was taken into sterile plastic containers, and simultaneously the urine sample and the nitrite test were done by the use of urine dipstick test. Data were analyzed using SPSS software version 23. Results: The results of the urine culture test indicated that the highest excreted organisms in both sexes were E. coli (58.8%), Candida (17.6%), Klebsiella (8.8%), E. coli (MDR) (5.9%), Pseudomonas (2.9%), Enterococcus (2.9%) and Acinetobacter (2.9%). The results showed that there was a significant correlation between U/C and urine analysis (U/A) test results (P = 0.01), and in U/C positive results, U/A results were significantly positive for UTI. Other findings showed a significant relationship between the results of nitrite one and nitrite two tests (P = 0.001). There was a significant correlation between urinary, and nitrite1 levels (P = 0.04). Also, in this study, the sensitivity and specificity of diagnostic tests for U/A and nitrite 1 and 2 with U/C were calculated as the Golden Standard method. Conclusion: Overall, the results of this study showed that the negative nitrite test and urine dipstick test could be performed in emergency cases to prevent ectopic dysfunction and inadequate diagnosis. Also, it can reduce the unreasonable expenses for U/A.

Objectives: Urine dipstick is the first step laboratory test to diagnose a urinary tract infection (UTI) which is a common infectious disease diagnosed in the laboratories. Early treatment of UTI is very important in order to prevent long-term complications. The gold standard to diagnose UTI is urine culture so there are a number of unnecessary urine culture requests. However, urine culture results are not available earlier than 24-36 hours. Besides, urine culture is expensive and causes time-consuming of treatment. Our aim in this study was to compare urine leukocyte esterase test and nitrite test of urine dipstick with urine culture to determinate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Methods: Urine culture results and urine dipstick test results of patients who admitted to Selçuk University Hospital between May 2016 and May 2017 were collected retrospectively. The study included 11.169 patients and 3299 of them have positive urine cultures. Results: In total, 3299 (29.5%) patients have positive urine culture. Out of these culture positive samples, positive dipstick results’ ratios for leukocyte esterase and nitrite were 82.8% (n = 2733) and 22.4% (n = 774). Leukocyte esterase had 82.8% sensitivity and 68.1% specificity, with PPVs and NPVs of 52.1% and 90.5%, respectively. Conclusions: The NPVs are found significantly higher than PPVs and it shows that urinary dipstick is more reliable to exclude disease than to diagnose the disease. Clinicians should not order urine culture from all patients without ant clinic signs.

Background Urinary tract infections (UTIs) are one of the most common infections in primary care. Previous research showed that GPs find it challenging to diagnose UTIs and frequently divert from guidelines leading to unwarranted antibiotic prescriptions and inefficient use of diagnostics such as urinary cultures. We hypothesise that management of UTIs during out-of-hours care may be extra challenging due to a higher workload and logistical issues regarding diagnostic work-up and obtaining results. We therefore aimed to study the workload, diagnostic work-up and treatment of UTIs during out-of-hours primary care. Methods We performed a retrospective observational cohort study in which we analysed a full year (2018) of electronic patient records of two large Dutch GP out-of-hours centres. All adult patients with UTI symptoms were included in this study. Descriptive statistics and multivariate regression were used to analyse diagnostics and subsequent management. Results A total of 5657 patients were included (78.9% female, mean age of 54 years), with an average of eight patients per day that contact a GP out-of-hours centre because of UTI symptoms. Urinary dipsticks were used in 87.5% of all patients visiting the out-of-hours centres with UTI symptoms. Strikingly, urinary cultures were only requested in 10.3% of patients in which urinary culture was indicated. Seventy-four percent of the patients received antibiotics. Seventy-nine percent of the patients with a negative nitrite test still received antibiotics. Remarkably, patients at risk of complications because of a UTI, such as men, received fewer antibiotic prescriptions. Conclusions In total, 74% of the patients received antibiotics. 8 out of 10 patients still received an antibiotic prescription in case of a negative nitrite test, and 9 out of 10 patients with an indication did not receive a urine culture. In conclusion, we found that correctly diagnosing UTIs and prescribing antibiotics for UTIs is a challenge that needs major improvement, especially during out-of-hours GP care.

To determine the clinical utility/disutility of canceling urine cultures in elderly patients with a negative dipstick. The cohort included consecutive patients aged ≥ 65 years hospitalized in internal medicine departments with an admission urinalysis and urine culture (January 1, 2014 to December 31, 2016). We calculated the sensitivity of the dipstick (either a trace leukocyte esterase or a positive nitrite test result) to detect patients with bacteriuria, and the decrease in urine cultures resulting from cancelation in patients with a negative dipstick. We reviewed the charts of patients with a positive culture but negative dipstick to determine if they received appropriate antibiotic therapy and if the culture results had clinical utility, defined as changes in antibiotic therapy made according to culture results in a patient who did not respond to initial antibiotic therapy. The sensitivity of the dipstick for bacteriuria was 90.8% (95% CI, 89.6-92.0%). Of the 210 patients with a positive culture but negative dipstick, 132 (62.9%) had a diagnosis clearly outside the urinary tract. Thirty-five patients (16.7%) received inappropriate differential antibiotic therapy. Urine cultures did not have clinical utility and canceling urine cultures in those with a negative dipstick would result in a 41.5% (95% CI, 40.3-42.7%) decrease in urine cultures. We conclude that canceling orders for urine cultures in the elderly patient with a negative dipstick did not have clinical disutility and would decrease inappropriate antibiotic therapy. Extrapolation to other settings is dependent on urinalysis methodology, patient selection, and physician ordering and treatment behaviors.

Aim. To study prevalence and etiological structure of urinary tract infections (UTIs) in pregnant women with type 1 diabetes mellitus, to assess sensitivity of various methods of UTIs detection. Materials and methods. 192 pregnant women with type 1 diabetes mellitus (DM1) were examined. The presence of a urinary infection was assessed by detection of nitrites, leukocyte esterase in general urinalysis and by bacteriological culture with the use of the classical and "DipStrik" express method. Results. UTI has been detected in 57.3%. The frequency is as follows: asymptomatic bacteriuria (> 105 cfu /ml) (ABU) – 35.9% (n=69), acute pyelonephritis – 19.8% (n=38), acute cystitis – 1.6% (n=3). The proportion of low ABU (102-104 cfu/ ml) is 16.1% (n=31). Escherichia coli prevailed in the structure of pathogens of UTI: in ABU – 66.7%, in pyelonephritis – 78.9%. Then goes Enterococcus faecalis : in ABU – 14.5%, in pyelonephritis – 13.2%; and then Klebsiella : in ABU – 7.2%, in pyelonephritis – 5.3%. Other pathogens ( Streptococcus agalactiae, Staphylococcus aureus, Proteus ) were less common. Sensitivity of the nitrite test to detect UTI was 30%; sensitivity of leukocyte esterase detection for low ABU was 22.6%, for ABU – 52.2%, for pyelonephritis –71%. Sensitivity of the express method "DipStrik" with reference to classical bacteriological culture was 98%. Conclusion. The structure of UTI in DM1 differs from that of in pregnant women without DM. In DM1 a "significant" ABU dominates over a low ABU. The share of manifest forms of UTI in DM1 is much higher than in pregnant without DM. In the structure of UTI pathogens in pregnant women with DM1 gram-positive microbes (E. faecalis, S. agalactiae and S. aureus) have a greater proportion compared with pregnant women without DM, in which more than 80% of UTI pathogens are gram-negative (E. coli, K pneumoniae and Proteus) . Cultural methods still remain the gold standard of UTI detection, and especially its asymptomatic forms. Moreover, the "DipStrik" express method of bacteriological culture has sensitivity comparable to the classical culture (in our study 98 %).

Introduction: Urinary tract infection (UTI) is the most common serious bacterial infection in young infants. Signs and symptoms are often nonspecific. Objectives: To describe clinical, demographic and laboratory features of UTI in infants ≤ 3 months old. Methods: Cross-sectional study of infants ≤ 3 months old with UTI diagnosed in a pediatric emergency department, for the period 2010-2012. UTI was defined as ≥ 50,000 colony-forming units per milliliter of a single uropathogen isolated from bladder catheterization. Paired urinalysis and urine culture from group culture-positive and group culture-negative were used to determine the sensitivity and specificity of pyuria and nitrite tests in detecting UTI. Results: Of 519 urine cultures collected, UTI was diagnosed in 65 cases (prevalence: 12.5%); with male predominance (77%). The most common etiologies were Escherichia coli (56.9%), Klebsiella pneumoniae (18.5%) and Enterococcus faecalis (7.7%). Frequent clinical manifestations were fever (77.8%), irritability (41.4%) and vomiting (25.4%). The median temperature was 38.7°C. The sensitivity of the nitrite test was 30.8% (95%CI:19.9-43.4%), specificity of 100% (95%CI:99.2-100%). Pyuria ≥ 10,000/mL had a sensitivity of 87.7% (95%CI:77.2-94.5%), specificity of 74.9% (95%CI:70.6 -78.8%). The median peripheral white blood cell count was 13,150/mm3; C-reactive protein levels were normal in 30.5% of cases. Conclusions: The male: female ratio for urinary tract infection was 3.3:1. Non-Escherichia coli etiologies should be considered in empirical treatment. Fever was the main symptom. Positive nitrite is highly suggestive of UTI but has low sensitivity; whereas pyuria ≥ 10,000/mL revealed good sensitivity, but low specificity. Peripheral white blood cell count and C-reactive protein concentration have limited usefulness to suggest UTI. RESUMO Introdução: A infecção do trato urinário (ITU) é um quadro infeccioso grave mais frequente em lactentes jovens, cujos sinais e sintomas são frequentemente inespecíficos. Objetivos: Descrever aspectos clínicos, demográficos e laboratoriais de ITU em lactentes ≤ 3 meses. Métodos: Estudo transversal de ITU diagnosticada em lactentes ≤ 3 meses, em pronto-socorro geral de pediatria, entre 01/01/2010 a 31/12/2012. Diagnóstico de ITU definida como crescimento ≥ 50.000 unidades formadoras de colônia por mililitro de uropatógeno único, colhido por cateterismo vesical. Urina tipo I e urocultura foram pareadas dos grupos cultura-positiva e cultura-negativa para determinar a sensibilidade e especificidade de piúria e teste do nitrito para o diagnóstico de ITU. Resultados: Das 519 uroculturas colhidas, confirmou-se 65 casos de ITU (prevalência: 12,5%), com predomínio em meninos (77%). As etiologias mais frequentes foram Escherichia coli (56,9%), Klebsiella pneumoniae (18,5%) e Enterococcus faecalis (7,7%). Os sintomas mais frequentes foram febre (77,8%), irritabilidade (41,4%) e vômitos (25,4%). A temperatura mediana foi de 38,7°C. A sensibilidade do nitrito positivo foi de 30,8% (IC95%:19,9-43,4%), especificidade de 100% (IC95%:99,2-100%). Piúria ≥ 10.000/mL apresentou sensibilidade de 87,7% (IC95%:77,2-94,5%), especificidade de 74,9% (IC95%:70,6-78,8%). A contagem mediana de leucócitos foi 13.150/mm3. A proteína C reativa foi normal em 30,5% dos casos. Conclusões: A proporção entre meninos e meninas para ITU foi de 3,3:1. Outros agentes além de Escherichia coli devem ser considerados no tratamento empírico. A febre foi a principal queixa. O nitrito positivo é altamente sugestivo de ITU mas tem baixa sensibilidade; enquanto que a piúria ≥ 10.000/mL revelou boa sensibilidade, porém baixa especificidade. Leucograma e proteína C reativa demonstraram pouca utilidade clínica para sugerir ITU.

AIM: This study evaluated using urine dipstick tests with the clean-catch method to screen for urinary tract infection (UTI) in febrile infants under 90 days of age. METHODS: We carried out a comparative diagnostic accuracy study of infants under 90 days old, who were studied for unexplained fever without any source, in the emergency room of a hospital in Madrid from January 2011 to January 2013. We obtained matched samples of urine using two different methods: a clean-catch, standardised stimulation technique and catheterisation collection. The results of the leucocyte esterase test and nitrite test were compared with their urine cultures. RESULTS: We obtained 60 pairs of matched samples. A combined analysis of leukocyte esterase and, or, nitrites yielded a sensitivity of 86% and a specificity of 80% for the diagnosis of UTIs in clean-catch samples. The sensitivity of leukocyte esterase and, or, nitrites in samples obtained by catheterisation were not statistically different to the clean-catch samples (p = 0.592). CONCLUSION: Performing urine dipstick tests using urine samples obtained by the clean-catch method was an accurate screening test for diagnosing UTIs in febrile infants of less than 90 days old. This provided a good alternative to bladder catheterisation when screening for UTIs. Sin financiación 2.265 JCR (2018) Q2, 43/125 Pediatrics 1.031 SJR (2018) Q1, 51/318 Pediatrics, Perinatology and Child Health, 528/2844 Medicine (miscellaneous) No data IDR 2018 UEM

In a primary care study of urinary tract infections (UTIs) performed 2008 in Uppsala County, Sweden, 43% of the patients were culture negative. In order to investigate the background to the observed overdiagnosis of UTI, study invitations were sent to the previously included patients. A total of 256 patients (88% women) approved to participate. Patient charts and recorded laboratory data were reviewed. Two or more of the cardinal symptoms were reported in 53% of the women and in 19% of the men. A dipstick test was performed in 93% of the consultations. The highest positive predicted values in women had a positive nitrite test (95%, 95% CI 87; 99) and dysuria in combination with urgency (81%, 95% CI 72; 88). Seventy-one percent of the women who fulfilled the symptom criteria received an antibiotic prescription directly, 87% of these had a positive culture. The drug of choice was pivmecillinam for women (51%) and quinolones (50%) for men. The treatment duration was too long for the women; 68% were treated for ≥7 days. In conclusion, the adherence to national guidelines/recommendations was inadequate. To reduce the selection of multiresistant bacteria, an improvement of the use of diagnostic criteria/tools and antibiotic drugs in primary care is necessary.

The urine dipstick is used in combination with other clinical and microbiologic data to diagnose urinary tract infections (UTIs). It is usually ‘first-line’ in diagnosis given the ease of testing, low cost, and ability to use as a point-of-care test. Two components of the dipstick that are utilized in assisting in the diagnosis of UTIs are leukocyte esterase and nitrites. Leukocyte esterase is an enzyme that is released by white blood cells (WBCs) and therefore correlates with pyuria. Some bacteria (such as E. coli) convert urinary nitrates that are routinely present in the urine into nitrite. Therefore, a positive nitrite test on the urine dipstick is suggestive of the presence of these organisms. Importantly, a positive dipstick result only suggests the presence of bacteriuria and does not help in distinguishing between asymptomatic bacteriuria and symptomatic UTI. False positive and false negative dipstick tests are also common, and consideration should be given to the clinical context when interpreting results. When considering the diagnosis of a urinary tract infection, the dipstick result should therefore be used with careful interpretation of symptoms, urine microscopy, and urine culture along with consideration of other potentially confounding diagnoses such as sexually transmitted infections (STI) and vaginosis.

Introduction: Urinary Tract Infection (UTI) is a significant health problem in young women and adolescent females. Microscopic analysis and/or urine culture are costly, labour intensive laboratory-based tests. For many individuals, access and affordability for such care can be difficult specially in India rural settings have limited resources for this. The concept of selfscreening for UTI by urine dipstick bedside method and benefits of adopting it as a regular school health programme is relatively new in our country. Aim: To evaluate the ability of self screening for UTI by urine dipstick method in the adolescent school girls. Materials and Methods: In this cross-sectional study the ability to self screen for UTI in 374 participants, including 184 girls from a rural school and 190 girls together from two urban schools was evaluated. At each school, the participants were educated about UTI and the objectives and methodology of the study. The participants reported to the school (to the investigators) within one hour of collecting first-morning, clean-voided, midstream urine sample in a sterile labelled container. The ability to self-interpret for UTI by the participants using dipstick method was evaluated. The interpretation by the investigator was considered the gold standard. Sensitivity, specificity and predictive values were calculated to assess the ability to self screen for UTI. The association between UTI and contributory factors was calculated using Chi-square tests. Results: The overall self screening ability of the participants for UTI was found to have sensitivity, specificity, positive and negative predictive values of 81.82%, 96.7%, 42.86% and 99.43%, respectively. The UTI was significantly associated with water intake (χ2 =11.196, p

Aim This study analysed the association between a positive nitrite dipstick test and an invasive bacterial infection (IBI) in infants younger than 90 days of age with fever without source (FWS). Methods We performed a secondary analysis of data from a prospective multicentre study of infants up to 90 days of age with FWS undergoing care in 19 paediatric EDs between October 2011 and September 2013. Invasive bacterial infection was defined as a positive blood or cerebrospinal fluid culture. Results The dipstick urinalysis was positive for nitrite or leucocyte esterase in 766 (22.5%) of the 3401 infants we studied, and 270 (35.2%) had a dipstick test that was just positive for nitrite. Overall, 107 were diagnosed with an IBI (3.1%). The IBI prevalence was 2.2% among patients with a normal urine dipstick, 4.4% if they had positive leucocyte esterase test results, 8.3% where the nitrite test was positive and 10.6% when both tests were positive. After multivariate analysis, a positive nitrite test remained an independent risk factor for IBI (odds ratio 2.7, 95% confidence interval 1.4-4.9). Conclusion In infants under 90 days of age with FWS, a positive nitrite urine dipstick test was an independent risk factor for IBI.

BACKGROUND: A recent study in young infants found that different cutoffs maximized the accuracy of the urine white blood cell count in dilute versus concentrated urine samples. We aimed to confirm this finding and to determine its impact on clinical care. METHODS: We conducted a retrospective analysis of data gathered on consecutive children RESULTS: We included 10 078 children. The ability to rule in UTI (as measured by the positive likelihood ratio [LR]) was similar in dilute and concentrated urine for the leukocyte esterase test (11.76 vs 10.71, respectively). The positive LR for urine white blood cell count per high-powered field was higher in dilute urine (9.83 vs 6.12). In contrast, the positive LR for the nitrite test was lower in dilute urine (20.54 vs 47.44). Despite these differences, we found little change in the number of children treated with antibiotics in predictive models that took urine SG into consideration. CONCLUSIONS: Although we found that urine SG influences the accuracy of some components of the urinalysis, its inclusion in the decision-making process had negligible effect on the clinical care of children with UTI.

Background: Urinary tract infection (UTI) is a common bacterial infection causing illness in children. It may be difficult to recognize UTI in children because the presenting symptoms and signs are non-specific, particularly in younger children. In addition, urine collection and interpretation of urine tests in children are not easy, and therefore, it may not always be possible to confirm the diagnosis unequivocally. The study was conducted to evaluate the value of the modified nitrite test in diagnosing urinary tract infection (UTI) in children.Methods: The study included 150 children of both sexes, aged below 5 years, who were examined due to suspicion of UTI. The efficacy of the modified nitrite test to predict culture positivity was studied.Results: Modified nitrite test was positive in 14 out of the 26 culture-positive urine samples (sensitivity 53.85%). The specificity, positive predictive value, and negative predictive value were 96.77%, 77.78%, and 90.91%. The overall diagnostic accuracy was 89.33%.Conclusions: Modified nitrite test is an effective rapid screening test for diagnosing pediatric UTI.

AimsResults of urinalysis are available earlier than urine culture results. If urinalysis can predict results of culture, early decision can be made on treatment and whether urine samples should be cultured. This study sought to compare the performance of urinalysis tests by automated test strip analyser (nitrite and leucocyte esterase) with flow cytometry (bacteria and white cell count) in different subpopulations and types of samples.MethodsConsecutive urine samples (n=2351) from a population with a median age of 45 years, 37.2% men, were tested. Sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the tests were calculated using contingency tables. The gold standard was positive urine culture with cut-off >105 CFU/mL.Results14% of the cultures were positive (95.6% monomicrobial, 74.7% Enterobacteriaceae). Overall, nitrite test was the most specific (98.7%) but the least sensitive (43.2%). Bacteria count was the most sensitive (91.7%) and highly specific (87.5%). In infants ConclusionsOverall, the performance of urinalysis is excellent. Flow cytometry tests performed better than automated test strip analyser in ruling out urine to be cultured.

Urine culture is the gold standard in the diagnosis of a Urinary Tract Infection (UTI). More simple tests are often used instead of urine cultures. To compare the sensitivity and specificity of the urine nitrite test and gram staining with urine culture, a cross-sectional study was conducted at RSUP H Adam Malik, from February to July 2017, with participants recruited by consecutive sampling. The data collected were sample characteristics, clinical manifestations, causal organisms, nitrite test, gram staining and urine culture results. The data were analysed using Fisher’s exact test with p < 0.05. A total of 60 samples were included. The organism encountered was Escherichia coli. The most frequent clinical manifestation was fever, exhibited by 37 children with UTIs. The sensitivity and specificity of the nitrate test were 64.8% and 86.9%, respectively, while the sensitivity and specificity of gram staining were 94.5% and 100%, respectively. Gram staining is a good alternative test for diagnosing UTIs, but nitrite testing still needs further research.

Objective The aim of this study was to identify predictive factors for bacteremia conveniently and quickly among outpatients diagnosed with pyelonephritis. Patients All patients who were diagnosed with pyelonephritis at the outpatient clinic in the Department of General Medicine of Juntendo University Hospital from April 1, 2008, to June 30, 2015, were enrolled. Patients from whom blood cultures had not been taken were excluded. Methods Clinical information was extracted from medical charts. Factors potentially predictive of bacteremia were analyzed using a t-test and Fisher's exact test, followed by a multivariable logistic regression model analysis. Results Blood cultures were drawn from 116 patients, and 25 (22%) presented with bacteremia. A multivariate analysis with the age, chills, platelet count and urine nitrite test results revealed that older age, positive urinary nitrite test results and chills tended to be associated with bacteremia, respectively. [older age: unit odds ratio (OR) 1.02, p=0.052, 95% confidence interval (CI) 1.00-1.05, positive urinary nitrite test findings: OR 2.5, p=0.092, 95% CI 0.86-7.7, chills: OR 2.5, p=0.096, 95% CI 0.84-7.65]. The area under the receiver operating characteristic (ROC) curve of this model was 0.77. Regardless of age, positive urinary nitrite test findings were significantly associated with bacteremia (OR 3.1, p=0.033, 95% CI 1.1-9.2), and chills tended to be associated with bacteremia (OR 2.7, p=0.07, 95% CI 0.93-7.9) The area under the ROC curve of this model was 0.75. Conclusion Bacteremia should be considered in pyelonephritis patients with rapidly assessable factors in outpatient clinic. In particular, a model including a urinary nitrite test has the potential to aid in the prediction of bacteremia.

Background: Urinary tract infection (UTI) is one of the most common bacterial infections, annually affecting 150 million people worldwide. The highest prevalence of UTI in the overall elderly population. However, practical problems have occurred in urine sampling in diaper-wearing elderly people. Our aim is to develop a new type of the in-vitro diagnostic devices based on “cotton”, which allows us to detect the nitrite concentrations in urine (i.e., biomarker for urinary tract infection). The combination of cotton-based diagnostic device and a smartphone-based image analysis would help the healthcare people early diagnose urinalysis-based diseases such as UTI, and improve the life quality in elderly populations around the world. Methods: Our diagnostic device integrated into diaper is made up with three primary parts: a test pad, a flow channel made by hydrophobic and hydrophilic cotton and plastic packaging substrates. The smartphone-based image analysis (a specific APP) solved recording issues including variances in either light or focal distance. The mean value was calculated and analyzed based on 8-bit grayscale using ImageJ software and defined as 255– [experiment zone intensity]. Results: The nitrite test color changes from colorless to purple, correlating positively to concentration (from 0.156 to 5 µM) in both test paper only and test pad integrated with diaper and the mean value is calculated and analyzed. Conclusions: Since this device is inexpensive, portable, simple, structurally integrating with diapers and functionally integrated with the smartphone-based application, it would have a wild range potential of becoming a commercially viable diagnostic system, in particular, for the daily healthcare of elderly people.

Background : Urinary tract infection (UTI) is a major global public health issue. The gold standard for diagnosing UTI is urine culture. This is however labour intensive and time consuming. Many prescribers therefore rely on urinalysis in diagnosing UTI. This study sought to evaluate the performance of some parameters of urinalysis as predictors of urine culture positivity. The common causative agents and their antibiotic susceptibility patterns were also determined. Methods : A cross sectional study was carried out at the University of Cape Coast Hospital from July 2017 – December 2017 among out-patients. The performance characteristics of leukocyte esterase (3+) and nitrite reactions were estimated and compared with urine culture. Antimicrobial susceptibility tests were done using disc diffusion technique described by Kirby-Bauer. Results : Prevalence of UTI in this study was 30.0% (64/213). The most prevalent pathogen was E. coli (20, 31.2%), followed by S. saprophyticus (9, 14.1%). Most of the bacteria (52, 94.5%) were sensitive to amikacin, followed by ciprofloxacin (42, 76.3%). The most sensitive (94.4%) of the parameters was pus cells [>5 white blood cells (WBC) per high power field (HPF)] and the least sensitive was the nitrite test (21.0%). The leukocyte esterase test showed the highest accuracy of 91.1%. Conclusion : The study supports the recommendation of the use of oral ciprofloxacin as the first line treatment of uncomplicated UTI by the Ghana Standard Treatment Guidelines (2017). Funding : No funding was provided for this study. Keywords : urine tract infection, urinalysis, uropathogens, Cape Coast

Background Urinary tract infection (UTI) is a common disease in children. Approximately 3-5% of girls and 1 % of boys develop a UTI. In children, prompt treatment is essential because UTI may be a risk factor for developing renal insufficiency or end stage renal disease. Howevet; prompt treatment depends on having a rapid diagnosis. Urine dipstick testis a useful and commonly used because it is low cost and gives rapid results, compared to urine cultures for diagnosing UTis. However, the diagnostic accuracy of the urine dipstick test is debatable. Objective To compare urine dipstick test (leukocyte esterase, nitrite, and combined leukocyte es terase and nitrite) to urine culture for diagnosing UTis. Methods A diagnostic study was held in H. Adam Malik Hospital from May to June 2010. There were 70 children aged 2 to 14 years and recruited by consecutive sampling. Two midstream urine specimens were collected from subjects after cleaning the external urethral orifice. The first specimen was used for urine dipstick testing for leukocyte esterase and nitrite. The second urine specimen was cultured in the laboratory. Urinalysis for leukocyte esterase and nitrite studies were performed with fresh and uncentrifuged urine. Leukocyte esteras e and nitrite caused a change in dipstick color apparent within 2 minutes. Urinalyses were considered to be positive for UTI if either leukocyte esterase or nitrite were positive. The results of urine culture were used as the golden standard. Results The sensitivities of leukocyte esterase and nitrate tests were 90 .5% and 73.8%, respectively. However, the sensitivity for combined leukocyte esterase and nitrite test was 96.4%. Nitrite test was more specific (60.7%) than the leukocyte esterase test (39.3%). The specificity of both tests taken together was 64.3% . For leukocyte esterase alone, nitrate alone, and the two combined the positive predictive values (PPV) were 69.1 %, 73.8%, and 64.3.%, respectively, and the negative predictive values (NPV) were 73.3%, 60.7%, and 96.4%, respectively. Conclusion Urine dipstick test for leukocyte esterase and nitrite combined may be a good alternative diagnostic test for UTis in children than leukocyte esterase or nitrite by themselves in areas with limited resources.

Background:Diagnostic urinary tract infection (UTI) studies have primarily been performed among female patients.Aim:To create a diagnostic algorithm for male general practice patients suspected of UTI.Design and setting:Surveillance study in the Dutch Sentinel General Practice Network.Method:Clinical information and dipstick results were collected from 603 patients. Algorithm-predicted care was compared with care as usual in terms of sensitivity (antibiotic recommended when UTI was confirmed) and specificity (no antibiotic recommended when no UTI was observed).Results:Complete information was available from 490/603 (81 %) males, of whom 66 % (321/490) had a UTI. A diagnostic algorithm recommending antimicrobial prescription in the case of a positive nitrite test or a positive leukocyte esterase test in males aged >= 60 years, had a positive predictive value (PPV) of 83 % (95 % confidence interval [CI] = 78 to 87) and a negative predictive value (NPV) of 60 % (95 % CI = 52 to 66), respectively (area under the ROC curve: 0.78, 95 % CI = 0.74 to 0.82). When both dipstick results were positive in males aged >= 60 years, PPV increased to 90 % (95 % CI = 83 to 94), whereas NPV was highest in males >= 60 years with negative dipstick results (71 %, 95 % CI = 59 to 81). Sensitivity and specificity of predicted UTI care and usual care did not differ (75 % versus 79 %, P = 0.30, and 70 % versus 63 %, P = 0.17, respectively).Conclusion:UTI care provided to Dutch male GP patients is as accurate as predicted care from a diagnostic algorithm. The studied clinical information and dipstick tests are useful for ruling in UTI in males, but have limited value in ruling out this diagnosis.

Urinary tract infection is one of the most frequently seen medical complications in pregnancy. UTI in pregnancy is an important concern, as it possesses risk of complications such as acute and chronic pyelonephritis, toxaemia, anaemia, hypertension, intrauterine growth retardation and increased perinatal mortality. The detection of bacteriuria allows an approach to be made for the prevention of chronic urinary disease in the community and to avoid complications in pregnancy at an early stage. OBJECTIVES: (1) To study the prevalence of bacterial pathogens causing urinary tract infection among pregnant women; (2) To evaluate the sensitivity of the screening test with culture. MATERIALS AND METHODS: A total of 500 samples were investigated from pregnant women aged between 18 to 35 years, with varying gravida and from all three trimesters were included in a period of one year i.e., from January to December 2011. The samples were collected aseptically from women attending the antenatal clinic at the Khaja Banda Nawaz Hospital, Gulbarga. Urine was collected in the sterile urine container. Both macroscopic and microscopic examination was done. Screening tests like Griess Nitrite test and TTC tests were done. Culture was done by standard loop technique. RESULTS: The prevalence rate of UTI in pregnancy was 10.40% i.e., with significant bacteriuria (1,00,000 or more bacterial count/ ml of urine) by Kass concept. The incidence of bacteriuria increased along with age and rising parity. Incidence was similar during all three trimesters. Gram’s staining, TTC and Griess nitrite gave 88.46%, 73.07% and 57.69% respectively correlate with culture positive bacteriurics. CONCLUSIONS: UTI, the most commonly seen complications in pregnancy was 10.4%. Early treatment of bacteriuria not only averts the occurrence of other complications, but also diminishes the risk of premature and perinatal mortality.

Actinobaculum schaalii is a new species that has so far been isolated from human blood, urine and pus. Its importance has probably been underestimated and other Actinobaculum spp. may also have been underdiagnosed. This retrospective study comprises all known cases of A. schaalii infections identified since 2004 in the canton of Neuchâtel (170 000 inhabitants), Switzerland. Strains were cultivated and isolated in the bacteriology laboratory using its routine procedure. Identification included a Rapid ID 32 A strip (bioMérieux) and 16S rRNA gene sequencing. Twenty-one positive samples were found in 19 patients (11 male, 8 female) of all ages (range 16–91 years): 10 from urine (50%), six from blood (30%), one from both blood and urine (5%), and three from pus (15%). Thirteen out of 17 (76%) cases with either blood or urine specimens had underlying genitourinary tract pathologies. When urine cultures were positive for A. schaalii, leucocytes were found in all samples (10/10, 100%) but all nitrite tests were negative (10/10, 100%). The onset of appropriate treatment was delayed due to the diminished sensitivity of A. schaalii to the antibiotics commonly used for UTIs (i.e. ciprofloxacin and trimethoprim/sulfamethoxazole) and to the delay in microbiological diagnosis. A. schaalii should specifically be searched in all cases of leukocyturia with a negative nitrite test but with Gram-positive rods in the Gram stain, in patients with underlying genitourinary tract pathology, instead of dismissing these findings as clinically irrelevant colonization by coryneform bacteria. This infection may be much more common than previously thought.

The diagnostic performance of six methods for bacteriuria testing has been studied in 781 urine specimens obtained in primary health care, using conventional culture as reference method. The cut-off limits for classification of test results into positive and negative have been optimized with respect to diagnostic performance in primary health care. With optimized tests the following diagnostic efficiencies were obtained: 1) Bacterial ATP, 0.94; 2) Bacterial count in sediment, 0.93; 3) Nitrite test, 0,92; 4) Dipslide test, 0,92; 5) White cell count in sediment; 0,87; 6) Granulocyte esterase test; 0.83. The diagnostic performance was also studied for all combinations of two tests. The highest diagnostic efficiency (0.96) was obtained by combining the ATP and dipslide tests. High diagnostic efficiencies can be obtained by a rapid primary test, using other tests for follow-up testing of specimens with intermediate or uninterpretable primary results. The most promising results were obtained by using ATP as the primary test, with follow-up testing of specimens with 3–25 nmol/l of ATP (12 per cent of the specimens). Follow-up testing by conventional culture resulted in overall diagnostic efficiency of 0.98. By performing the nitrite test on specimens with intermediary ATP-results, 81 per cent of the patients with UTI can be classified without culture. Only patients with intermediary ATP and negative nitrite results (10 per cent of the total number) will have to wait for final diagnosis based on conventional culture. Some alternative strategies to combine available methods are discussed in detail. Major advantages of the ATP test are that the test can be performed while the patients are waiting; it provides a numerical and objective result, and, in contrast to culture, it is not influenced by adhesion of bacteria to somatic cells.

As part of the search for a satisfactory screening test for bacteriuria suitable for mass detection, a comparison has been made of the tests that might be useful (Uroscreen, T.T.C. test, nitrite-nitrate incubation test, catalase test, and microscopy of urine for bacteriuria and pyuria) and of quantitative urine culture, which have been carried out in parallel. The results have been compared with the earlier published results obtained by the respective methods. None of the above screening tests has been found to fulfil the demands that should be placed on a test designed for mass detection. As regards the Uroscreen, T.T.C., and nitrite-nitrate incubation tests and microscopy of the urine for bacteriuria, their sensitivity was good but their specificity unacceptably low. Microscopy for pyuria and the catalase test showed too low sensitivity and specificity. The nitrite test was the only test with acceptable specificity but its sensitivity was too low to render it acceptable as the only screening method for mass detection. Various types of simplified urine-culture methods and Schersten's glucose method remain to be evaluated.

The aim of this study was to determine whether hyperbilirubinemia affects the association between a positive urine nitrite test and a positive urine culture.We conducted an institutional review board-approved, retrospective review of 12 months of patient data, compiling information for patients having urinalysis, urine culture, and total serum bilirubin. Patients were divided into 3 groups according to total serum bilirubin: less than 1.5 mg/dL, 1.5 to 3.0 mg/dL, and greater than 3.0 mg/dL. The point estimates and 95% confidence intervals of the sensitivity, specificity, false-positive proportion (proportion of false positive to all positive tests), and other test characteristics of urine nitrite as an indicator of urinary tract infection were calculated and tested for trend as a function of the 3 total serum bilirubin ranges.Three thousand one hundred seventy-four patients met our study criteria. Specificity of the nitrite test decreased as a function of increasing total serum bilirubin (0.974, 0.966, and 0.855 for the 3 total bilirubin levels, respectively) with a significant trend (P.0001). There was no significant trend in comparable sensitivity values (0.380, 0.417, and 0.241, respectively) with P = .55. The false-positive proportion also increased as a function of total serum bilirubin (17.5%, 17.3%, and 72.0%) with P.0001. Thus, if a patient's total serum bilirubin was elevated to the point of jaundice (3.0 mg/dL), it was approximately 4 times more likely that a positive urine nitrite test would be a "false positive" (ie, nitrite-positive/culture-negative) compared with those with normal serum bilirubin levels.Specificity of the urine nitrite test for urinary tract infection decreases as a function of increasing serum bilirubin. Most patients with hyperbilirubinemia and a positive nitrite test in our sample did not have an associated urinary tract infection.

Purpose Some urinary tract pathogens are capable of reducing nitrates to nitrites, including Escherichia coli, Klebsiella, Proteus, and Serratia. A urinalysis (UA) is commonly performed in patients with symptoms of a urinary tract infection (UTI) in order to detect the presence of nitrites in the urine. The objectives of this study were: 1) to assess the predictive value of the nitrite test in distinguishing nitrate-reducing pathogens from non-reducing pathogens; 2) to determine whether the results of the nitrite test can predict the susceptibility of the urine pathogen to several common antibiotics. Methods A retrospective cross-sectional chart review identified inpatients who had a UA and a positive urine culture (UC). Patients were divided into nitrite-positive and -negative groups based on UA results. Urine pathogens were identified by culture and antibiotic susceptibilities and were compared within the groups. Results Eighty-six UAs were included. A nitrite-positive UA had a 90.6% positive predictive value in identifying a nitrite-producing pathogen. A nitrite-negative UA had a negative predictive value of 33.3% in identifying a non-nitrite producing pathogen. There was no difference in the antibiotic susceptibility for ampicillin, gatifloxacin, and trimethoprim/sulfamethoxazole between the groups. Conclusions A nitrite-positive result indicates a high likelihood of the presence of a nitrite-producing organism. However, a negative nitrite test is a poor predictor of the absence of nitrite-producing pathogens. Therefore, patients with a positive nitrite test on UA can be treated empirically for a nitrite-producing organism until confirmatory laboratory studies can be completed. A nitrite-negative UA is not useful in ruling out a nitrate-reducing organism.

In their article which appears in this issue of Pediatric Nephrology, Dr. S. Swerkersson and co-workers claim that as many as one in every five infants with a true episode of urinary tract infection (UTI) will be missed with the commonly used cut-off level of ≥10(5) colony forming units (CFU)/mL. This controversial finding is supported by the results of seven previous studies including a total of 1587 children. Dr. E.H. Kass, who in the 1950s suggested the presently used cut-off level, knew at the time that it excluded a number of patients with a true infection. Later studies in adult patients also showed that up to 46–49% of women with a likely diagnosis of cystitis had low bacterial counts. These findings can, if true, improve our understanding of cases of unexplained postinfectious renal scarring. Children with low bacterial counts during an acute infectious episode have a significant risk of receiving delayed or even no antimicrobial treatment. The results of scientific studies are also confounded if 20 % of the subjects with a true infection are wrongly included in a control group diagnosed as having no UTI due to low bacterial counts. This problem cannot be easily solved by lowering the cut-off level and generally accepting that any bacterial count signifies a Btrue^ infection as this approach will drastically reduce the specificity of the culture result. Instead, as many as possible urine samples for culture should be collected from babies, infants and small children with a suprapubic bladder puncture, or a catheterised sample. In such samples bacterial counts as low as 103 CFU/mL are generally regarded as significant. In many cases, however, the only possibility is a Bclean catch^ or bag sample. In these situations, the treating physician needs to take all relevant clinical and laboratory parameters into account and if clinically important data support the diagnosis of a UTI not disregard this diagnosis based only on low bacterial counts. C-reactive protein or procalcitonin can, in a febrile child, help the physician differentiate between a febrile bacterial UTI and a viral infection. A positive nitrite test provides, albeit with a low sensitivity, strong support for a UTI diagnosis.

Aims: Urine dipstick analysis is a quick, cheap and a useful test in predicting Urinary Tract Infection (UTI) in hospitalized patients. Our aim is to evaluate the reliability (sensitivity) of urine dipstick analysis against urine culture in the diagnosis of UTI. Materials and Methods: Patients admitted to our hospital suspected of having UTI, with positive urine cultures were included in this study from a 2-year period (January 2011 to December 2012). Dipstick urinalysis was done using multistix 10 SG (Siemens) and clinitek advantus analyzer. The sensitivity of dipstick nitrites, leukocyte esterase and blood in these culture-positive UTI patients was calculated retrospectively. Results: Urine dipstick analysis of 635 urine culture-positive patients was studied. The sensitivity of nitrite alone and leukocyte esterase alone were 23.31% and 48.5%, respectively. The sensitivity of blood alone in positive urine culture was 63.94%, which was the highest sensitivity for a single screening test. The presence of leukocyte esterase and/or blood increased the sensitivity to 72.28%. The sensitivity was found to be the highest when nitrite, leukocyte and blood were considered together. Conclusions: Nitrite test and leukocyte esterase test when used individually is not reliable to rule out UTI. Hence, symptomatic UTI patients with negative dipstick assay should be subjected to urine culture for a proper management.

Background:Urinary tract infections (UTIs) are common bacterial infections dominated by lower UTI in women (LUTIW). Symptoms only are insufficient for diagnosis and accordingly, near patient diagnostic tests confidently confirming significant bacteriuria are desirable. The nitrite test (NIT) has low sensitivity, while bacterial and leukocyte counts disjunctively paired in urine sediment microscopy (SED) have high sensitivity. Similar symptomatic cure rates are found post antibiotic vs. placebo therapy in patients with negative cultures. Consequently, prescription on symptoms only implies unnecessary antibiotic therapy.Aims:to evaluate the diagnostic outcomes of NIT, SED and NIT disjunctively paired with SED (NIT+SED) vs. urine culture, with special focus on bladder incubation time (BIT), and to assess if NIT+SED can reduce unnecessary antibiotic therapy.Methods:A diagnostic, primary care, multicentre study including 1070 women with symptoms suggestive of lower UTI.Results:Significant bacteriuria was found in 77%. The BIT highly influenced the diagnostic outcomes and the optimal duration was 􀀂4h with sensitivity of 66, 90 and 95% for NIT, SED and NIT+SED, respectively. SED performed only in NIT negative specimens could reduce unnecessary antibiotics by 10% vs. prescription on symptoms only. The number needed to test with SED to reduce one unnecessary antibiotic course was five patients at BIT ≥4h and six patients at ≤3h or overall.Conclusion:The BIT highly influences the diagnostic outcomes with the highest accuracy of NIT+SED. Diagnosis of LUTIW with NIT+SED can reduce unnecessary antibiotic therapy and subsequently decrease antimicrobial resistance.Trial registration:The Swedish Medical Product Agency 1995 03 01:151:01783/94.

To assess bacterial aetiology, antimicrobial susceptibility and efficacy of empirical treatment in uncomplicated urinary tract infections and to evaluate the dipstick as a diagnostic tool.Prospective study.Clinical microbiology laboratory and 17 general practice clinics in Telemark County, Norway.A total of 184 female patients between 15 and 65 years of age with symptoms of uncomplicated urinary tract infection.Results from dipstick testing (leucocyte esterase and nitrite), bacterial culture, susceptibility patterns and efficacy of empirical antibacterial therapy on symptoms.Significant bacteruria was detected in 140 (76%) of the 184 urines. The leukocyte esterase test was of little help in predicting culture-positive UTI. A positive nitrite test accurately predicted culture-positivity, while a negative result was ambiguous. The most common bacterium, E. coli, was found in 112 (80%) of the 140 positive urines and was predominantly sensitive to ciprofloxacin (100%), mecillinam (94%), nitrofurantoin (97%), trimethoprim (88%), and sulphonamide (81%), and to a lesser extent to ampicillin (72%). In 18 patients the causative bacterium was resistant to the therapeutic agent used; 7 of these returned to their GP with persisting symptoms while in 11 symptoms resolved without further treatment.The study confirms E. coli as the predominant cause of uncomplicated UTI. Since in the majority of cases the bacterium found was susceptible to the locally preferred antimicrobials and the patients' symptoms were cured, empiric therapy is found to be an effective practice in the study area and, by inference, in others with similar antimicrobial susceptibility patterns.

Objective Various point-of-care testing (POCT) urine analysers are commercially available for routine urine analysis in general practice. The present study compares analytical performance, agreement and user-friendliness of six different POCT urine analysers for diagnosing urinary tract infection in general practice. Setting All testing procedures were performed at a diagnostic centre for primary care in the Netherlands. Urine samples were collected at four general practices. Primary and secondary outcome measures Analytical performance and agreement of the POCT analysers regarding nitrite, leucocytes and erythrocytes, with the laboratory reference standard, was the primary outcome measure, and analysed by calculating sensitivity, specificity, positive and negative predictive value, and Cohen9s κ coefficient for agreement. Secondary outcome measures were the user-friendliness of the POCT analysers, in addition to other characteristics of the analysers. Results The following six POCT analysers were evaluated: Uryxxon Relax (Macherey Nagel), Urisys 1100 (Roche), Clinitek Status (Siemens), Aution 11 (Menarini), Aution Micro (Menarini) and Urilyzer (Analyticon). Analytical performance was good for all analysers. Compared with laboratory reference standards, overall agreement was good, but differed per parameter and per analyser. Concerning the nitrite test, the most important test for clinical practice, all but one showed perfect agreement with the laboratory standard. For leucocytes and erythrocytes specificity was high, but sensitivity was considerably lower. Agreement for leucocytes varied between good to very good, and for the erythrocyte test between fair and good. First-time users indicated that the analysers were easy to use. They expected higher productivity and accuracy when using these analysers in daily practice. Conclusions The overall performance and user-friendliness of all six commercially available POCT urine analysers was sufficient to justify routine use in suspected urinary tract infections in general practice.

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.

For 422 male patients with symptoms indicative of a urinary tract infection, nitrite and leukocyte esterase activity dipstick test results were compared with results of culture of urine samples. The positive predictive value of a positive nitrite test result was 96%. Addition of results of the leukocyte esterase test did not improve the diagnostic accuracy of the nitrite test.

This report describes two episodes of acute cystitis associated with “mixed flora” in an elderly male following a cystoscopy. The initial episode was accompanied by pyuria and a positive nitrite test. Both episodes responded to treatment with nitrofurantoin. Urine cultures were negative prior to the episodes and at a 1-year follow-up.

O diagnóstico de infecção do trato urinário (ITU) em porcas geralmente é feito com o auxílio de tiras reagentes, por ser um método rápido, prático e passível de ser realizado na própria granja. O exame microscópico da urina raramente é utilizado em granjas por ser uma técnica mais demorada e trabalhosa. No entanto, não existem estudos sobre a precisão destas duas técnicas no diagnóstico de ITU nesta espécie. O objetivo deste estudo foi avaliar a precisão da tira reagente e do exame microscópico da urina no diagnóstico de ITU em porcas, comparando-os com o exame bacteriológico da urina. Para selecionar as porcas que iriam compor o estudo foi realizado um exame químico prévio com tira reagente, do qual foram selecionadas 139 porcas, 66 positivas para nitrito na tira reagente e 73 negativas. No dia seguinte foi realizada uma nova coleta de urina destas 139 porcas para realização da urinálise completa, que incluiu os exames físico, químico, microscópico e microbiológico destas amostras de urina. Os resultados demonstraram que a prova de nitrito da tira reagente apresentou 100% de especificidade e 93% de sensibilidade. A especificidade do exame microscópico para bacteriúria foi de 82% e a sensibilidade de 100%. O diagnóstico de ITU com o uso de tiras reagentes e/ou com exame microscópico da urina é confiável, quando comparado com o exame bacteriológico da urina, o que torna possível o diagnóstico rápido de ITU em porcas na granja. The diagnosis of the urinary tract infection (UTI) in sows is usually performed by using reagent test strips, since it is a fast and practical method, and capable of being done at the farm. The microscopic examination of the urine is rarely used at the farm since it is a more time consuming and difficult technique. However, there are no studies on the accuracy of those two techniques for the UTI diagnosis on this species. This study aims to assess the accuracy of the reagent test strip and the urine microscopic examination in the diagnosis of ITU in sows, comparing them with the bacteriological examination of urine. In order to select the sows for this study, a chemical reagent test strip was carried out previously and a total of 139 sows were selected, 66 sows of which showed positivity to nitrite in the reagent test strip and 73 without nitrituria. Then, the next day, a new sample collection for performing a complete urinalysis was carried out from those 139 sows, which included physical, chemical, microscopic and microbiological examination of these urine samples. The results revealed that the nitrite test of the reagent strip showed 100% of specificity and 93% of sensitivity. The specificity of the microscopic examination for bacteriuria was 82% and the sensitivity was 100%. The UTI diagnosis by using reagent strips and/or the urine sediment test is reliable if compared to the urine bacteriological examination, which makes possible the rapid diagnosis of UTI in sows at the farm.

Objective: To establish the reliability of a new rapid enzymatic screening test, the Uriscreen, in the detection of significant bacteriuria in pregnancy. Methods: During a 6-month period, from July 1 to December 30, 1993, 313 consecutive pregnant patients were evaluated. Randomly voided, midstream, clean-catch urine specimens were used. Each sample was tested by routine laboratory culture and four rapid screening tests: the nitrite and leukocyte esterase dipstick, microscopic examination for pyuria, and the Uriscreen test. Results of the four rapid tests were compared with those of the urine culture. Results: Twenty-four women (7.6%) had urine culture results indicating significant bacteriuria. The sensitivity of the nitrite test, the leukocyte esterase test, and a microscopic examination for pyuria was low (37, 52, and 56%, respectively). The Uriscreen test showed very high sensitivity (100%), lower specificity (81%), a high predictive value of negative results (100%), and a low positive predictive value (30%). Conclusions: The Uriscreen test is a reliable alternative to culture screening of all pregnant patients. A policy of performing a urine culture during pregnancy only on patients with a positive Uriscreen test will save as much as 80% of unnecessary cultures.

So far, the validity of urine dipslides has been studied only under optimal conditions, which may not reflect the situation in daily practice.We studied the validity of the urine dipslide as performed under daily practice conditions and assessed the influence of the incubation period (24 h versus 48 h) on validity.Fresh urine samples of patients with signs/symptoms of a possible urinary tract infection (UTI) were examined in general practice via a nitrite test, a urine sediment and a dipslide. A second dipslide was inoculated and sent to the hospital microbiology laboratory for culture. This culture acted as gold standard. We calculated the sensitivity and specificity of the tests performed.Of the 273 patient episodes included, 62% had a UTI (166 of 268 cultures). The sensitivity of the dipslide performed in daily general practice was 73% and the specificity was 94%.The validity of the dipslide read under practice conditions is lower than under optimal conditions. Actions to improve performance are needed. Nonetheless, using the dipslide instead of the sediment as a second step after the nitrite test would improve the diagnostic work-up of UTI.

Urinary Tract Infection (UTI) is a common problem in pregnancy due to the morphological and the physiological changes that take place in the genitourinary tract during pregnancy. Screening methods may be useful, because a full bacteriological analysis could be reserved for those patients who are symptomatic or those who have positive screening test results. The exact prevalence of UTI in rural, pregnant women is unknown. The present study was undertaken to estimate the prevalence of UTI in pregnant women and for ascertaining the utility of the Griess Nitrite test and the Urinary Pus Cell Count of ≥5 cells per micro litre test for the screening or the early detection of UTI in them at primary health care clinics. Occurrence of urinary complaints was compared in UTI and non UTI women.We conducted a study on 300 randomly selected, pregnant women from rural areas. Urine cultures, pus-cell counts and the Griess nitrite test were used for diagnosis of UTI. The screening tests for UTI were evaluated in terms of their sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and the percentage of correctly classified.In the present study, the prevalence of UTI was found to be 29/300 (9.6%, 95% confidence interval 9.57-9.63). The specificities of the two screening tests were comparable (97.05% and 94.47%). Also, the negative predictive values of the two tests were almost similar (97.77% and 96.96%). The percentage of correctly classified by the Griess nitrite test and the urine pus cell count were found to be 95.33% and 92.33% respectively. The proportion of the women with various urinary complaints was significantly higher (P0.00) in the UTI subjects as compared to that in the non-UTI subjects.Urine culture remains the gold standard for the detection of asymptomatic bacteriuria. The Nitrite test of uncentrifuged urine was observed to be the best among the screening tests which were evaluated in terms of their efficiency and validity.

Urinary tract infections (UTI) are the most frequent nosocomial infections of women during puerperium. Since, in these women, diagnostic accuracy is affected by lochial secretion, suprapubic urinary bladder puncture (SPB) is recommended. Between December 1989 and January 1993, we subjected 903 women to suprapubic urinary bladder puncture (SpBP) at the 4th or 5th day after delivery. A urine culture of SpBP was done in all cases. Semiquantitative leukocyte counts (n = 891) and nitrite test (n = 830) were done on mid-stream urine (MSU). Side by side with microbiological investigation for urinary tract pathogens via SpPB, MSU was performed in 246 cases immediately after SpPB had been carried out. Leukocyte counts were also estimated in SpBP urine samples. In 370 (41.1%) of 903 SpBP, one or more microorganisms were cultivated. Only 36 (4.0%) of 903 women showed UTI symptoms. Microorganisms were detectable via SpBP in only 26 (72.7%) of these 36 symptomatic patients. Vaginal-operative or secondary caesarean section are related to an increased UTI rate (p < 0.001). UTI were also significantly (p < 0.0001) more frequent in women subjected to catheterisation sub partu (54.5%) compared to no catheterism (24.4%). No significant differences between the number of leukocytes in MSU sediment and the SpBP findings were seen. Semiquantitative leukocyte counts in SpBP offered a significantly (p < 0.001) increased number of leukocytes in cases with microorganism detection in SpBP irrespective of MSU findings. These results justify the designation of uterine tract infection also in the absence of complaints as "infection" and not common "bacteriuria".(ABSTRACT TRUNCATED AT 250 WORDS)

Results of urinalysis and culture of 2181 urine specimens obtained by catheter from febrile children aged less than 24 months were analyzed to determine the following: (1) an optimal cutoff point in considering a bacterial colony count clinically "significant," (2) the accuracy of leukocyte esterase and nitrite tests in identification of pyuria and bacteriuria, and (3) the utility of pyuria (defined as > or = 10 leukocytes/mm3) in the discrimination of urinary tract infection from asymptomatic bacteriuria. Among 110 urine cultures with > or = 10,000 colony-forming units per milliliter, 92 (84%) had > or = 100,000 CFU/ml, 10 (9%) had 50,000 to 99,000 CFU/CFU/ml and 8 (7%) had 10,000 to 49,000 CFU/ml. Urine specimens with 1000 to 49,000 CFU/ml were more likely than specimens with > or = 50,000 CFU/ml to yield Gram-positive or mixed organisms (36/60 vs 7/109; p or = 10 leukocytes/mm3 was found in 93 of 102 patients with > or = 50,000 CFU/ml. The dipstick leukocyte esterase test had sensitivities of 52.9% and 66.7% in detecting > or = 10 leukocytes/mm3 and > or = 20 leukocytes/mm3, respectively. The dipstick nitrite test had a sensitivity of 31.4% in detecting bacteriuria (> or = 50,000 CFU/ml). Acute pyelonephritis was diagnosed by a renal scan with dimercaptosuccinic acid labeled with technetium 99m in 50 (77%) of 65 patients with > or = 10 leukocytes/mm3 but in none of five patients with or 10/mm3 and a CFU count > or = 50,000/ml. This definition almost always discriminates among true urinary tract infection, bacteriuria resulting from contamination of the urine specimen, and asymptomatic bacteriuria.

The purpose of our study was to characterize the utility of certain elements of urinalysis, singly or in combination, in identifying children with urinary tract infections (i.e., positive findings on urine culture). Laboratory results for urine specimens subjected to both urinalysis and culture in an on-site outpatient clinic (office) laboratory during a 36-month period were reviewed. All specimens were collected by one of three methods (the midstream void technique, urethral catheterization, or suprapubic aspiration of urine) from children with symptoms to assist in documenting a possible urinary tract infection. Specimen processing by certified technologists was initiated within 10 minutes of collection. Sensitivity, specificity, and positive and negative predictive values were determined for each test or combination of tests. Of 689 specimens, 102 (14.8%) had positive culture results. The combination of dipstick analysis (leukocyte esterase and nitrite tests) and of microscopic examination for bacteria had a sensitivity of 100% and a negative predictive value of 100%. The nitrite test had a specificity of 100% and a positive predictive value of 100%. We conclude that, when properly collected specimens are evaluated promptly by certified technologists, the rate of accuracy in detecting or ruling out a urinary tract infection (i.e., positive findings on urine culture) with certain elements of the urinalysis is high.

Urinary tract infection (UTI), a significant but preventable cause of morbidity in children, is an important risk factor for development of renal insufficiency. Having simple and reliable means of screening children facilitate its prompt treatment.To evaluate the use of dipstick test for leukocyte esterase (LE) and nitrite as screening tool in the diagnosis of UTI in children.This cross-sectional study was done in the department of Paediatrics, University of Port Harcourt Teaching Hospital (UPTH) from February to October 2005. Children 2 to 15 years with symptoms suggestive of UTI were studied. Midstream urine specimen was collected from each patient forLEtest, nitrite test and culture.Out of 139 children, 72(51.8 percent) males and 67(48.2 percent) females studied, 33(23.7 percent) had positive urine culture. The prevalence of UTI was significantly higher in females than in males (p=0.001). The LE dipstick test correctly identified 17 of the 33 patients with culture proven UTI, with 51.5 percent sensitivity and 79.2 percent specificity. The nitrite dipstick test showed 42.4 percent sensitivity and 93.3 percent specificity. The combination ofLEand nitrite correctly identified 24, giving 73 percent sensitivity and 75.5 percent specificity. The LE seemed to have a higher sensitivity as a screening tool in the diagnosis of UTI than nitrite, but the difference was not statistically significant (p=0.46). However, the combination of LE and nitrite provided a higher sensitivity than either of them with a statistically significant difference (p=0.04). Key words: Dipstick urinalysis, Screening tool

Urinary tract infection (UTI), a significant but preventable cause of morbidity in children, is an important risk factor for development of renal insufficiency. Having simple and reliable means of screening children facilitate its prompt treatment.To evaluate the use of dipstick test for leukocyte esterase (LE) and nitrite as screening tool in the diagnosis of UTI in children.This cross-sectional study was done in the department of Paediatrics, University of Port Harcourt Teaching Hospital (UPTH) from February to October 2005. Children 2 to 15 years with symptoms suggestive of UTI were studied. Midstream urine specimen was collected from each patient forLEtest, nitrite test and culture.Out of 139 children, 72(51.8 percent) males and 67(48.2 percent) females studied, 33(23.7 percent) had positive urine culture. The prevalence of UTI was significantly higher in females than in males (p=0.001). The LE dipstick test correctly identified 17 of the 33 patients with culture proven UTI, with 51.5 percent sensitivity and 79.2 percent specificity. The nitrite dipstick test showed 42.4 percent sensitivity and 93.3 percent specificity. The combination ofLEand nitrite correctly identified 24, giving 73 percent sensitivity and 75.5 percent specificity. The LE seemed to have a higher sensitivity as a screening tool in the diagnosis of UTI than nitrite, but the difference was not statistically significant (p=0.46). However, the combination of LE and nitrite provided a higher sensitivity than either of them with a statistically significant difference (p=0.04). Keywords: Sickle cell anaemia, premarital screening, Haemoglobin genotype.

Background: Although Kawasaki disease (KD) often presents with sterile pyuria, bacterial pyuria (urinary tract infection [UTI]) occasionally occurs. Methods: This was a retrospective cohort study of 285 children with KD diagnosed between 1995 and 2005. Among these patients, a total of 210 patients underwent routine urine tests and 75 children underwent urine culture tests. This study was conducted to investigate the incidence, clinical manifestations, management and outcome of KD with pyuria. Results: The incidence of pyuria was 29.5% (62/210). Among the 75 children undergoing urine culture tests, 34 had sterile pyuria (45.3%), eight had bacterial pyuria (10.7%), two had UTI without pyuria (2.7%) and 31 had neither pyuria nor UTI (41.3%). When pyuria was used as a predictor of KD with UTI, the positive and negative predictive values were 19% and 93.9%, respectively. There were no significant differences in demographic data, clinical presentations, laboratory results, duration of fever, ratio of resistant KD or risk level, except in the nitrite test, between both groups. Conclusions: Pyuria was not always sterile in patients with KD. Although there was no different clinical phenotype or coronary outcome in KD patients with or without UTI, we suggest that UTI should be considered and evaluated in KD patients with pyuria, a positive nitrite test or a positive result of urine culture. If UTI is definitively diagnosed, the patient should be treated for a UTI as well as for KD and complete post-UTI work-up is recommended.

Contains fulltext : 80454.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To study which tests general practitioners used to diagnose a urinary tract infection (UTI) in children and which patient characteristics were associated with test choice. DESIGN: Retrospective chart review on the diagnosis of UTIs in children in Dutch general practices who were diagnosed as having a UTI. A total of 49 general practices participated in the study, and provided information on 148 children aged 0-12 years old. RESULTS: The nitrite test, which is recommended as first step, was performed in 87% of the children during the first contact. Less than 30% of the children had a dipslide and 37% a cultured urine. About half of all children with a UTI diagnosis had a follow-up contact in general practice, and an average of 83% of these children had their urine tested. The recommended test, a dipslide, was performed in 26% of the children with a follow-up contact. Patient age and UTI history were associated with choice of test. CONCLUSIONS: The diagnostic procedures for UTIs in children in general practices could be improved, with focus on the importance of an accurate UTI diagnosis in all children, and explaining which tests should be performed and what the test results mean.

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.