Abstract
BackgroundUntreated bacteriuria during pregnancy has been shown to be associated with low birth-weight and premature delivery. Therefore, routine screening for bacteriuria is advocated. The decision about how to screen pregnant women for bacteriuria has always been a balance between the cost of screening versus the sensitivity and specificity. This study was designed to evaluate the diagnostic accuracy of the rapid dipstick test to predict urinary tract infection in pregnancy against the gold standard urine culture.MethodA total of 367 mid stream urine samples were collected, inoculated on MacConkey, Manitol salt agar (MSA) and blood agar and incubated aerobically at 37°C for overnight. Specimens were classified as “positive” for urinary tract infection (UTI) if the growth of the pathogen(s) was at a count ≥ 105 colony-forming units per milliliter (cfu/mL) of urine and classified as “negative” with growth of <105 cfu/mL. Urine samples were tested for the presence of nitrite and leukocyte esterase using dipstick rapid test in accordance to the manufacturer’s instructions.ResultsFrom the total study participants, 37 pregnant women were symptomatic and the remaining 330 pregnant women were asymptomatic. The sensitivity and specificity of dipstick tests of leukocyte esterase was 50% and 89.1% for pregnant women with asymptomatic UTI(ABU) and 71.4% and 86.7% for symptomatic UTI respectively and for nitrite 35.7% and 98.0% for ABU and 57.1% and 96.7% symptomatic UTI.ConclusionThis study revealed that the use of dipstick leukocyte esterase and nitrite for screening UTI particularly asymptomatic bacteriuria was associated with many false positive and negative results when it was compared against the gold standard culture method. The low sensitivity and positive predictive value of urine dipstick test proved that culture should be used for the diagnosis of UTI.
Highlights
Untreated bacteriuria during pregnancy has been shown to be associated with low birth-weight and premature delivery
This study revealed that the use of dipstick leukocyte esterase and nitrite for screening urinary tract infection (UTI) asymptomatic bacteriuria was associated with many false positive and negative results when it was compared against the gold standard culture method
The low sensitivity and positive predictive value of urine dipstick test proved that culture should be used for the diagnosis of UTI
Summary
Untreated bacteriuria during pregnancy has been shown to be associated with low birth-weight and premature delivery. The decision about how to screen pregnant women for bacteriuria has always been a balance between the cost of screening versus the sensitivity and specificity. UTI can be either symptomatic or asymptomatic, and patients with significant bacteriuria who have symptoms referable to the urinary tract are said to have symptomatic bacteriuria. Asymptomatic bacteriuria (ABU) is a condition characterized by bacteriuria without classical symptoms attributable to the urinary tract [4]. The relatively high prevalence of UTI asymptomatic bacteriuria during pregnancy, which will have significant consequences can be avoided with treatment if they are screened early for bacteriuria. The decision about how to screen asymptomatic women for bacteriuria has always been a balance between the cost of screening versus the sensitivity and specificity [5]. The correctness of the laboratory test in determining the individual status is crucial not to give false positive or negative results that may lead to unnecessary prescription of drug or inappropriate management
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