Utility of urine dipstick in predicting urinary tract infection in pediatric outpatients

Abstract

Objectives: Children are most frequently affected by urinary tract infections (UTIs). Urine dipsticks along with use in urine routine testing can help in predicting UTI. In this study we aim to evaluate the utility of individual and combination of urine dipstick parameters, including nitrite and leukocyte esterase (LE), against gold standard urine culture for detection of UTI among pediatric outpatients. Materials and Methods: Nine hundred and forty-nine pediatric urine samples from January 2021 to December 2021 were cultured on Cysteine Lactose Electrolyte Deficient Agar and incubated at 37°C overnight. Siemens Multistix 10SG strips were used to perform a urine dipstick for urine markers. Results from the urine dipstick and culture were contrasted. Statistical Analysis: Data obtained in the study was analyzed statistically using stata version 15. Diagnostic performance of urine dipstick parameters was assessed taking urine culture as gold standard. Receiver operating characteristics (ROC) curve was plotted. Results: About 153 of the 949 urine samples received for culture were positive. Males comprised 102 of the 153 positive patients. The most common organism isolated was Escherichia coli, followed by Klebsiella, Pseudomonas, and Proteus. LE, nitrite, red blood cells (RBC), and protein had a sensitivity of 77.1%, 64.7%, 45.1%, and 46.4%, respectively, whereas their specificities were 94.5%, 97.2%, 95.9%, and 93.1%, respectively. When taken together, “LE and Nitrite and RBC and Protein” had a lower area under the curve (AUC) of 0.641, whereas “LE/Nitrite/RBC/Protein” had the highest AUC of 0.914. Conclusions: The urine dipstick test may be utilized as a screening tool and a positive predictor for UTI. When evaluated simultaneously, nitrite and LE can be used as point-of-care tests preceding the culture examination for decision-making. They can aid in the optimized management of children by minimizing UTI-related complications and inappropriate antibiotic use.