Title: Urine analysis as a predictor of urinary tract infection.
Abstract: Urinary tract infection is one of the most commonly encountered genitourinary
disease in pediatric practice. The clinical diagnosis of urinary tract infection is
difficult, due to non-specific or vague symptomatic spectrum seen in children. Use
of rapid diagnostictests like urine dipstick and microscopy,over the recent past was
found to be economical and effective in avoiding unnecessary sampling for urine
cultures.Although extensive pediatric studies have been done to evaluate the
performance characteristics of these rapid diagnostic tests in rightly diagnosing a
UTI, there is lack of sufficient studies and paucity of data on these in developing
countries like India.
This study focuses on reliability of urine dipstick and microscopy in early
detection of childhood urinary tract infection and the current status of urine
analysis as an effective screening tool in an Indian set up. This study looks at the
single as well as combination of parameters that provide maximum sensitivity and
specificity, providing a better diagnostic criteria in detecting an underlying urinary
infection.
OBJECTIVE:
To evaluate the usefulness of rapid diagnostic tests (dipstick and microscopy) in
predicting urinary tract infection in children.
METHODOLOGY:
Urine samples were obtained under strict aseptic precautions for both, urine
analysis and urine culture in 2 different containers. The samples for urine analysis
and urine culture were sent to clinical pathology lab and microbiology lab
respectively within 2 hours of collection. The decision to initiate an empirical
treatment, pending the urine culture reports was left to the treating physician. Urine
analysis was performed by a trained technician and urine culture was done by a
lab technician, under supervision of microbiologist. The results obtained from
urine analysis, which included both urine dipstick and microscopy were compared
with urine culture. 6 parameters such as leukocyte esterase, pyuria, nitrites,
bacteriuria, hematuria and albumin were compared with urine culture.
The results were divided into two groups- culture proven UTI and the sterile
culture groups. The true positive, true negative, false positive and false negative
values were obtained and specificity, sensitivity, positive and negative predictive
value were calculated for all the 6 parameters, single and in combination in both
the groups. The clinical profile of the patients who are confirmed cases of urinary
tract infection were also studied. The initiated therapy by the treating physician
was either altered or continued after reviewing the antibiotic sensitivity pattern in
the culture proven UTI cases.
RESULTS:
200 patients with suspected urinary tract infection were enrolled in the study. 100
patients with culture proven UTI and 100 patients with sterile urine cultures.
1. Among the culture proven UTI group, urine analysis was positive in 85
cases and negative in 15 cases. Urine analysis was positive in 33 cases and
negative in 64 cases in the sterile culture group.
2. Leukocyte esterase has maximum sensitivity of 81%.
3. Nitrites has a maximum specificity of 99%.
4. There was no significant correlation between parameters and age in the
culture proven UTI group, except for nitrites. Nitrites positivity significantly
increased as age increases.
5. The combination of leukocyte esterase with pyuria and nitrites had the
maximum sensitivity in this study.
CONCLUSION:
1. In predicting urinary tract infection, Nitrites and bacteriuria has a positive
predictive value of 93.1% and a combined specificity of 95%.
2. In predicting urinary tract infection, Leukocyte esterase and nitrites has a
combined sensitivity of 82% and negative predictive value of 83.3%.
3. In predicting urinary tract infection, Leukocyte esterase and bacteriuria has a
combined sensitivity of 82%.
4. Hematuria and albuminuria, as single parameters has poor sensitivity,
specificity and predictive values.
5. Nitrites positivity increases with age.
Publication Year: 2015
Publication Date: 2015-04-01
Language: en
Type: dissertation
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