Abstract
BackgroundDipstick test is widely used to support the diagnosis of urinary tract infections (UTI). It is effective in ruling out UTI, but urine culture is needed for diagnosis confirmation. In this study we compared the accuracy of voltammetric analysis (VA) with that of DT to detect UTI (diagnosed using urine culture), and its usefulness as a second-stage test in people with positive DT.Methods142 patients were enrolled with no exclusion criteria. VA was performed using the BIONOTE device. Partial Least Square Discrimination Analysis was used to predict UTI based on VA data; diagnostic performance was evaluated using sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LR), accuracy, diagnostic odds ratio (DOR).ResultsMean age was 76.6 years (SD 12.6), 57% were male. VA had a better overall performance respect to DT in detecting UTI with accuracy 81.7% vs 75.9%, specificity 90.8% vs 82.5%, PPV 75% vs 61.4%, positive LR 6.68 vs 3.5, DOR 17.7 vs 7.47; sensibility, NPV and negative LR of the two tests were similar. VA had an accuracy of 82.4% in discriminating bacterial from fungal infections. When added as a second-stage test, VA identified 9 of the 17 false positive patients, with a net specificity of 91.7%, sensitivity 54%, PPV 75% and NPV 81%.ConclusionsVA is a quick and easy method that may be used as a second stage after DT to reduce the number of urine culture and of inappropriate antibiotic prescriptions.
Highlights
Dipstick test is widely used to support the diagnosis of urinary tract infections (UTI)
Data from a meta-analysis showed that this test has a pooled sensitivity of 81%, and a pooled specificity of 77% [7], that is reduced by many condition, such as proteinuria, glycosuria, or bad preservation of the sample, and varies according to the pathogen agent or patients’ dietary pattern; despite the aforementioned limitations, this test is effective in ruling out UTI, but its usefulness to rule in infection remains doubtful [6, 8, 9]
The objective of this study is to evaluate the accuracy of an innovative and portable e-tongue system for voltammetric analysis (VA), able to directly work on urine samples and to provide results within a few minutes, to detect UTI compared to dipstick test (DT), using urine culture as the gold standard
Summary
Dipstick test is widely used to support the diagnosis of urinary tract infections (UTI) It is effective in ruling out UTI, but urine culture is needed for diagnosis confirmation. Urinary tract infections (UTI) are the most frequent bacterial infections in the general population, with a worldwide incidence of about 120–250 million cases per year [1,2,3]. Not surprisingly, they are the infectious disease that cause the highest global consumption of antibiotics [4], with inherent high risk of alterations of the normal vaginal and gastrointestinal microbiota, Compatible signs and symptoms are sufficient to make diagnosis of UTI in typical cases. Data from a meta-analysis showed that this test has a pooled sensitivity of 81% (95% CI 71–90%), and a pooled specificity of 77% (95% CI 69–86%) [7], that is reduced by many condition, such as proteinuria, glycosuria, or bad preservation of the sample, and varies according to the pathogen agent or patients’ dietary pattern (excessive vegetable intake); despite the aforementioned limitations, this test is effective in ruling out UTI, but its usefulness to rule in infection remains doubtful [6, 8, 9]
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