Leukocyte Esterase Dipstick Test Research Articles

Evaluation of Leukocyte esterase and Nitrite dipstick tests with routine urine microscopic analysis in detecting urinary tract infections

Evaluation of Leukocyte esterase and Nitrite dipstick tests with routine urine microscopic analysis in detecting urinary tract infections

Diagnostic evaluation of leukocyte esterase reagent strip in bedside rapid diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

Background: Spontaneous bacterial peritonitis (SBP) is the most common and serious infection of liver cirrhosis patients with ascites. If not intervened with early antibiotic treatment leads to high morbidity and mortality. Thus, early diagnosis and treatment of SBP are needed for survival. Leukocyte esterase reagent can aid in early diagnosis. Aims and Objectives: This study aimed to assess the diagnostic accuracy of the leukocyte esterase dipstick test for the diagnosis of SBP in resource poor settings. Materials and Methods: This cross-sectional study was conducted during August 2018–January 2019 on patients with cirrhotic liver disease and ascites in a tertiary care medical college hospital, Puducherry. All patients underwent abdominal paracentesis, and ascitic fluid was subjected to cell counts, biochemistry tests, culture, and leukocyte esterase test (Multistrix SG8- Seimens) at 120 s and graded with five levels. Grade 3 was positive (125 polymorphonuclear leukocytes [PMNL]/mL) and grade 4 (<500/mL), which exceeds the threshold for SBP (<250 PMNL/mL). Sensitivity, specificity, positive, and negative predictive value (PPV and NPV) was calculated. Results: A total of 50 ascitic fluids were analyzed. Nine out of 50 (18%), 16 (32%), and 4 (8%) were positive for cell count method, Leucocyte esterase reagent (LER) test and culture, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for LER test were 6.25%, 91.18%, 25%, 67.39%, and 64%, respectively. Conclusion: The LER strip test is useful for SBP diagnosis in an emergency and resource poor setting. It provides good diagnostic accuracy and high NPV and it is cost effective and better bedside tool for SBP diagnosis.

Utilizing Dipsticks to Measure Leukocyte Esterase in Urine to Detect UTIS

Objective: The more expedient, less labor-intensive dipstick has come to be the tool of choice for diagnosing UTIs in the majority of primary care settings. The purpose of this study was to assess the usefulness of dipsticks in UTI diagnosis. Study Design: Descriptive study Place and Duration: Pathology Department Civil Hospital LUMHS. January 2021 to December 2021 Methods: Total 230 patients of both gender were presented in this study. The study included every urine sample that was received for urine culture by the Microbiology Department. The leukocyte esterase content of each specimen was measured using a urine dipstick. On Cysteine Lactose Electrolyte Deficient (CLED) agar, all of the urine samples were also used for culture. Every data was analysed using SPSS 24.0. Results: There were majority 125 (54.3%) females and 105 (45.7%) females among all cases. There were 75 (32.6%) LE positive and 120 (52.2%) were LE negative. Culture positive cases was 87 (37.8%) and 143 (62.2%) were culture negative. We found sensitivity (78.2%), specificity (86%), PPV (55.7%) and NPV (90.4%). The overall effectiveness of the LE Test with dipsticks was observed (84.3%). Conclusion: Under resource-constrained environments, the leukocyte esterase dipstick test is a quick and affordable screening method. Determining whether a urinary tract infection is present is very helpful. A negative test, however, gives a more accurate indication that a UTI is absent. Keywords: Urine culture, Urinary Tract Infection, Leukocyte esterase dipsticks

Biomarkers for febrile urinary tract infection in children.

The current reference standard for pediatric urinary tract infection (UTI) screening, the leukocyte esterase (LE) dipstick test, has suboptimal accuracy. The objective of this study was to compare the accuracy of novel urinary biomarkers to that of the LE test. We prospectively enrolled febrile children who were evaluated for UTI based on their presenting symptoms. We compared the accuracy of urinary biomarkers to that of the test. We included 374 children (50 with UTI, 324 without UTI, ages 1-35 months) and examined 35 urinary biomarkers. The urinary biomarkers that best discriminated between febrile children with and without UTI were urinary neutrophil gelatinase-associated lipocalin (NGAL), IL-1β, CXCL1, and IL-8. Of all examined urinary biomarkers, the urinary NGAL had the highest accuracy with a sensitivity of 90% (CI: 82-98) and a specificity of 96% (CI: 93-98). Because the sensitivity of the urinary NGAL test is slightly higher than that of the LE test, it can potentially reduce missed UTI cases. Limitations of using urinary NGAL over LE include increased cost and complexity. Further investigation is warranted to determine the cost-effectiveness of urinary NGAL as a screening test for UTI.

Diagnostic Accuracy of Leucocyte Esterase Dipstick Test for The Diagnosis of Spontaneous Bacterial Peritonitis in Children with Nephrotic Syndrome

Spontaneous bacterial peritonitis (SBP), which has a high fatality rate if antibiotics are not given promptly, is one of the most serious side effects of nephrotic syndrome and ascites. Therefore, it is essential for survival to diagnose and treat SBP early. A quick dipstick test for leukocyte esterase can identify the SBP. Objective: To determine the diagnostic accuracy in detection of SBP using leucocyte esterase dipstick test in children with nephrotic syndrome taking ascitic fluid neutrophil count as gold standard. Methods: A Cross Sectional Study was carried out Khyber teaching hospital and LRH Peshawar Pakistan. This research covered patients of either gender with nephrotic syndrome and ascites. On admission, diagnostic paracentesis was performed. The ascitic fluid collected at the bedside was examined immediately using a reagent strip. The PMN cell count in ascitic fluid was then determined. A positive +3 result on a leukocyte esterase dipstick was declared positive for SBP while absolute neutrophil count more than 250 cells per mm3 was considered confirmatory. Results: A total of 107 patients were enrolled. Age of the patients ranged from 4 to 14 years. Mean age of the patients was 6.68 ± 1.239 years. Male to female ratio was 1.7: 1. The sensitivity, specificity, positive and negative predictive value of leucocyte esterase dipstick test were 86.4%, 92.0%, 73.1% and 96.4% respectively. Conclusion: It is concluded that reagent strips are quick, practical, and low-cost diagnostics with good sensitivity and specificity for identifying SBP in children with nephrotic syndrome

Analytical validation of five diagnostic tests for the detection of polymorphonuclear cells in stallion semen.

The objectives of this study were to evaluate the ability of five diagnostic tests to detect polymorphonuclear cells (PMNs) in stallion semen, and to determine the concentration of PMNs that affects sperm motility. We hypothesized that all tests have diagnostic value, and even low concentrations of PMNs affect motility. One ejaculate was obtained from six stallions. Aliquots of 50×106 purified sperm were incubated, in triplicate, with six concentrations of purified PMNs: 1) no PMNs, 2) 0.25×106 PMN/ml, 3) 0.5×106 PMN/ml, 4) 2.5×106 PMN/ml, 5) 5×106 PMN/ml, 6) 10×106 PMN/ml. The PMNs were quantified using a hemacytometer, cytology, a leucocyte esterase dipstick test (LEDT), a peroxidase test, and CD13 immunolabeling. Sperm motility was evaluated after 4 h at 38 °C. The number of leucocytes detected with the LEDT differed among treatments (P<0.0001), from negative results in control samples to moderate or large numbers in the samples with the highest PMN concentration. The hemacytometer count and CD13 immunostaining detected differences with the control treatment at the lowest PMN concentration (2.5×106 PMN/ml; P<0.001). Sperm motion was lower in samples with ≥5×106 PMN/ml (P<0.0001). Thus, a sample was considered leucospermic if it contained ≥5×106 PMN/ml. The LEDT had the best sensitivity (100%), followed by cytology (78%), peroxidase test (60%), CD13 immunostaining (56%) and hemacytometer count (47%). The LEDT had the lowest specificity (65%), which was 95% for all other tests. In conclusion, the LEDT was a simple, economic and sensitive stall-side test to screen semen for presence of PMNs. Because of the lower specificity, positive LEDT results should be confirmed with the identification of peroxidase-positive cells or CD13-positive cells.

Diagnostic Validity of Leucocyte Esterase Dipstick Tests for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

Background: One of the worst sequelae of cirrhosis and ascites is spontaneous bacterial peritonitis (SBP). Early detection and treatment of SBP are therefore essential for survival because this complication is linked to a high death risk if antibiotics are not administered promptly. Leukocyte esterase dipstick testing can identify the SBP quickly. Objective: To evaluate the diagnostic accuracy of leucocyte esterase dipstick test for the detection of spontaneous bacterial peritonitis taking ascitic fluid neutrophil count as gold standard. Study Design: Cross Sectional Study Settings: Department of Gastroenterology, Lady Reading Hospital, Peshawar Study Duration: This study was conducted from 1st July 2021 till 30th June 2022 Materials and Methods: Two samples (10cc each) of ascitic fluid aspirate were obtained from patients with cirrhosis on admission to the hospital, presenting with ascites, fever and abdominal pain. Bedside leucocyte esterase dipstick test was performed on one sample and the other was sent to hospital laboratory for ascitic fluid analysis for neutrophil count. The results of both modalities were compared diagnostic accuracy which was recorded in terms of sensitivity, specificity, positive predictive value and negative predictive. Results: Mean age of the patients was 46.68 ± 10.239 years. A total of 170 patients were enrolled. Age of the patients ranged from 18 to 75 years. Male patients were 113 (66.5%) while 57 patients (33.5%) were female. Hepatitis C was the leading cause of cirrhosis observed in 89 patients (52.4%). The sensitivity, specificity, positive and negative predictive value of leucocyte esterase dipstick test observed were 89.7%, 96.2%, 87.5% and 96.9% respectively. Conclusion: Leucocyte esterase dipstick test is a convenient, inexpensive and rapid diagnostic modality for SBP with better diagnostic accuracy. Keywords: Spontaneous Bacterial Peritonitis, Leucocyte Esterase Dipstick test, Diagnostic Accuracy.

Diagnosis of spontaneous bacterial peritonitis in patients with chronic liver disease: Role of leukocyte esterase dipstick test.

Objective: To find out the efficiency of leukocyte esterase reagent strip (LERS) testing for the diagnosis of spontaneous bacterial peritonitis (SBP). Study Design: Cross Sectional, Validation study. Setting: Department of Medicine, Unit-III, Bahawal Victoria Hospital, Bahawalpur. Period: January-December 2019. Material &amp; Methods: A total of 235 patients of both gender, aged 18-60 years, having CLD with ascites, with any child pugh class and duration of CLD between 6-12 months were enrolled. Ascitic fluid was obtained at bedside and immediately dispatched for testing in a clean and dry test tube with reagent strip Multistix® 10 SG. Screening tests were calculated for accuracy of LERS test with respect to confirmed cytology testing. Results: Majority, 152 (64.7%) were male, 94 (40.0%) between 51-60 years age group and 146 (62.1%) had child pugh class C. Overall, mean age was noted to be 46.82+9.45 years. LERS testing turned out to be positive among 138 (5837%) cases. Confirmation of SBP through cytology was noted among 141 (60.0%). Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of LERS for the diagnosis of SBP with respect to cytology confirmation was calculated to be 90.8%, 89.4%, 92.8%, 86.6% and 90.2% respectively. Conclusion: The LERS testing was found to have high SE, SP, PPV, NPV and diagnostic accuracy in diagnosing SBP among patients of CLD with ascites. LERS can be used at bedside while it very simple and easy to perform.

Diagnosis of leucospermia in the stallion

The lack of standardized tests and interpretative criteria makes the diagnosis of stallion leucospermia difficult. Our objectives were to evaluate the ability of six diagnostic tests to detect polymorphonuclear cells (PMNs) in stallion semen, and to determine the concentration of PMNs that affects sperm motility. We hypothesized that all tests have diagnostic value, and that low concentrations of PMNs affect sperm motility. One ejaculate was obtained from six stallions. Aliquots of 50 ×106 purified sperm from each stallion were incubated with six concentrations of purified PMNs: 1) no PMNs, 2) 0.25 ×106 PMN/ml, 3) 0.5 ×106 PMN/ml, 4) 2.5 ×106 PMN/ml, 5) 5 ×106 PMN/ml, and 6) 10 ×106 PMN/ml. Each treatment was performed in triplicate. The PMNs were quantified using a hemacytometer (phase contrast microscopy), cytology (light microscopy), a commercial leucocyte esterase test (dipstick), a commercial peroxidase test (light microscopy), and immunolabeling of the neutrophil marker CD13 (flow cytometry). Sperm motility was evaluated after 4 h at 38 °C. The frequency of results obtained with the esterase test differed among treatments (P<0.0001). Negative or trace results were observed only with ≤ 0.5 ×106 PMNs/ml. A small number was observed in intermediate samples. In samples with ≥ 5 ×106 PMN/ml, only moderate or large results were obtained. Among quantitative tests, the hemacytometer count and flow cytometry detected differences with the control treatment at the lowest PMN concentration (2.5 ×106 PMN/ml; P<0.001). Total and progressive sperm motility were lower in samples with ≥5 ×106 PMN/ml than in those with lower concentrations (P<0.0001). Thus, a sample was considered leucospermic with ≥ 5 ×106 PMN/ml. The leucocyte esterase dipstick test had the best sensitivity (100%), followed by cytology (78%), peroxidase test (60%), flow cytometry (56%) and hemacytometer count (47%). The esterase test had the lowest specificity (65%), whereas the specificity of all other tests was 95%. In conclusion, presence of ≥5 ×106 PMNs/ml was associated with impaired sperm motility. The leucocyte esterase dipstick test is a simple, economic and sensitive stall-side test to screen semen for presence of PMNs in quantities capable of affecting sperm motility. Because of the lower specificity, we recommend confirming positive esterase results with the identification of peroxidase-positive cells under light microscopy, or CD13-positive cells using flow cytometry.

COMPARATION OF EFFECTIVENESS OF NORMAL SALINE AND 10% POVIDONE IODINE IN PERIURETHRAL CLEANING

&#x0D; Currently, urinary tract infection incidence in patients with indwelling urinary catheter ranges between 10-80%. They are at risk for other problems that can cause death. Appropriate action is required to decrease urinary tract infection risk by periurethral area cleaning. The aim of this study is to analyze the differences of the effectiveness of the use of normal saline and 10% povidone iodine for periurethral area cleaning in decreasing urinary tract infection risk. Research methods uses experimental design with the population of patients who used indwelling urinary catheter. Samples were obtained by consecutive and allocation by randomization which were divided into 2 groups, each group were 17 respondents. In the treatment group, periurethral area was cleaned with normal saline and in the control group with 10% povidone iodine. Urinary tract infection risk assessment was carried out by the leukocyte esterase dipstick test at 8 hours after insertion. The results indicate that the incidence of urinary tract infections risk in the group using normal saline smaller than 10% povidone iodine with a comparison of 1:1.3. Number need to treat in this study was 6. The conclusion of this study is normal saline is more effective in reducing urinary tract infection risk.&#x0D;

Diagnostic Accuracy of Point-of-care Nitrite and Leukocyte Esterase Dipstick Test for the Screening of Pediatric Urinary Tract Infections.

Our study aimed to evaluate the diagnostic performance of point-of-care nitrite and leukocyte esterase (LE) dipsticks in the diagnosis of suspected urinary tract infection (UTI) in infants <6 months (young infants) versus older children. The secondary objectives were to study the dipstick efficacy in children with congenital anomalies of the kidney and urinary tract (CAKUT) versus those without CAKUT; in children with simple UTI versus complicated UTI; and to evaluate the clinico-microbiological profile of children presenting with UTI. In this prospective observational study, cases with suspected UTI were enrolled from pediatric emergency or outpatient departments. Urine was collected for performing the urine dipstick and culture. Descriptive data regarding CAKUT, age, gender, etc., were recorded in a predesigned pro forma. We screened 506 children with suspected UTI, of whom 221 had urine culture positive. Approximately 38.4% of the children with UTI had underlying CAKUT, while 7.6% had renal scars. The most common CAKUT was vesicoureteric reflux (VUR). About 12 patients (2.3%) were known to have CAKUT at the time of enrollment in the study. In infants <6 months, LE dipstick had sensitivity 92%, specificity 89.7%, positive predictive value (PPV) 86.7%, negative predictive value (NPV) 93.8%, likelihood ratio (LR) + 8.9, LR- 0.09. In infants <6 months, nitrite dipstick had sensitivity 38%, specificity 97%, PPV 90.4%, NPV 68%, LR+ 12.6 and LR-0.63. In the age group 6 months to 12 years, the efficacy was better for both dipsticks. In age group more than 6 months to 12 years, LE dipstick had sensitivity 96.4%, specificity 95.8%, PPV 94.8 %, NPV 97.2%, LR+ 22.9, LR- 0.04. In age group more than six months to 12 years, nitrite dipstick had sensitivity 94.7%, specificity 99.5%, PPV 99.3%, NPV 96%, LR+ 189.4, and LR-0.05.

Reevaluating the true diagnostic accuracy of dipstick tests to diagnose urinary tract infection using Bayesian latent class analysis.

Previous studies on diagnostic accuracy of dipstick testing for leukocyte esterase (LE) and nitrite to diagnose urinary tract infection (UTI) had used urine culture, which is an imperfect gold standard. Estimates of diagnostic accuracy obtained using the classical gold standard framework might not reflect the true diagnostic accuracy of dipstick tests. We used the dataset from a prospective, observational study conducted in the emergency department of a teaching hospital in southern India. Patients with a clinical suspicion of UTI underwent dipstick testing for LE and nitrite, urine microscopy, and urine culture. Based on the results of urine microscopy and culture, UTI was classified into definite, probable, and possible. Patients with microscopic pyuria and a positive urine culture were adjudicated as definite UTI. Unequivocal imaging evidence of emphysematous pyelonephritis or perinephric collections was also considered definite UTI. We estimated the diagnostic accuracy of LE and nitrite tests using the classical analysis (assuming definite UTI as gold standard) and two different Bayesian latent class models (LCMs; 3-tests in 1-population and 2-tests in 2-populations models). We studied 149 patients. Overall, 64 (43%) patients had definite, 76 (51%) had probable, and 2 (1.3%) had possible UTI; 7 (4.6%) had alternate diagnoses. In classical analysis, LE was more sensitive than nitrite (87.5% versus 70.5%), while nitrite was more specific (24% versus 58%). The 3-tests in 1-population Bayesian LCM indicated a substantially better sensitivity and specificity for LE (98.1% and 47.6%) and nitrite (88.2% and 97.7%). True sensitivity and specificity of urine culture as estimated by the model was 48.7% and 73.0%. Estimates of the 2-tests in 2-populations model were in agreement with the 3-tests in 1-population model. Bayesian LCMs indicate a clinically important improvement in the true diagnostic accuracy of urine dipstick testing for LE and nitrite. Given this, a negative dipstick LE would rule-out UTI, while a positive dipstick nitrite would rule-in UTI in our study setting. True diagnostic accuracy of urine dipstick testing for UTI in various practice settings needs reevaluation using Bayesian LCMs.

Evaluation of rapid screening methods in the diagnosis of urinary tract infection

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

Current Management of Urinary Tract Infection and Vesicoureteral Reflux.

Urinary tract infection (UTI) is defined as the growth of a significant number of microorganisms of a single species in the urine, in the presence of symptoms. Symptoms in young children are non-specific such as fever without focus; young infants may manifest with irritability, failure to thrive, jaundice, vomiting and diarrhea. Older children usually have symptoms of cystitis or pyelonephritis. Symptoms of cystitis are dysuria, frequency, new onset incontinence and malodorous urine while symptoms of pyelonephritis are high grade fever, flank pain and vomiting. Rapid urine testing by microscopy for pus cells, dipstick testing for leukocyte esterase and nitrite, and enhanced urinalysis are supportive tests. Urine culture samples should be collected with proper technique and results interpreted for significant growth accordingly. Antibiotic therapy for 7-14 d for complicated UTI and 3-4d for uncomplicated UTI is adequate. Further evaluation is recommended clinically for bladder-bowel dysfunction and obvious anatomical defects and by imaging for vesicoureteral reflux (VUR), usually by micturating cystourethrography (MCU). Since MCU involves exposure to radiation and urethral catheterization, it is now reserved for children with parenchymal involvement or recurrent UTI. VUR is the backward flow of urine into one or both ureters. Clinical manifestations other than UTI include incidental diagnosis on antenatal ultrasonography. Reflux nephropathy, the renal scarring associated with VUR may manifest clinically as hypertension, proteinuria and renal failure. The management of VUR is primarily with antibiotic prophylaxis. Anatomical correction is indicated in case of breakthrough febrile UTI. No intervention has been shown to reduce renal scarring.

Curative Efficacy of Fosfomycin Tromethamine Versus Ciprofloxacin in the Initial Therapy of Uncomplicated UTI—a Prospective Open-Label Randomised Controlled Clinical Study

The precise current role of fosfomycin in the management of uncomplicated UTI (uUTI) is not well defined in the published English literature (PubMed(™)). We aim to compare the overall curative efficacy, safety, and outcome of fosfomycin tromethamine vis-a-vis Ciprofloxacin therapy in the initial management of uncomplicated UTI in a select group of patients. After obtaining prior institutional ethical clearance and written informed consent, 120 consenting patients with uUTI were selected as per protocol (based on symptoms of uUTI, positive urine culture sensitivity (c/s), urine routine/microscopy (r/m) or positive urine leukocyte esterase dipstick (LED) test) and enrolled in this study. They were randomized by computer draw of lots, into two groups of 60 each, randomised to receive initial empirical therapy with either fosfomycin (F-intervention arm) or Ciprofloxacin (C-comparator arm), pending the urine culture report. Patients were followed up with urine culture analysis and other parameters. The primary outcome measures were clinical/bacteriological response/resolution of UTI documented by negative urine culture (sent on day 3), absence of pyuria, and negative urine LED on 3rd day. Urine c/s was sent at day 0, but treatment was started (based on randomization) for those with urine r/m positive and positive LED test, pending the result of c/s. If the urine c/s turned out to be negative, the patient was excluded from the study. For the patients who satisfied the inclusion criteria, urine c/s was again sent on day 3, based on which report, bacteriological cure was defined. Secondary outcomes included bacteriological spectrum, antimicrobial sensitivity pattern, incidence of UTI caused by extended spectrum beta-lactamase (ESBL) producing strains of Escherichia coli, possible risk factors for UTI, side effects, ADRs, and ADEs of the drugs. E. coli and Klebsiella were the commonest cause of UTI while ESBL uropathogens were detected in 14/120 (11.67% 11 and 3 in F/C groups, respectively) patients. The sensitivity of uropathogens to F and C was 86 and 50% respectively while the overall clinical curative efficacy (CCE) of same was 83 and 43% respectively. In the subset of 14 patients with UTI due to ESBL, the CCE of F and C was 91 and 67% respectively. Side effects (minor and self-limiting) were significantly more common with the F group (p < 0.001), with diarrhoea being the commonest. Hospitalization was the commonest risk factor for UTI (27%) though the association of risk factors with UTI was not significantly different (p = 0.609). Fosfomycin was safe and significantly more efficacious in treating uncomplicated UTI (p < 0.001) versus ciprofloxacin. The overall incidence of UTI due to ESBL strains was 12% in which the CCE of fosfomycin was significantly higher (p = 0.023).

How Sensitive are Dipstick Urinalysis and Microscopy in Making Diagnosis of Urinary Tract Infection in Children?

Background:Urinary tract infection (UTI) is a common reason for referral to the emergency department (ED) especially in unwell infants. Upper UTIs are particularly at risk of significant complications later in life. Rapid dipstick urinalysis and microscopy are often used in unwell children as a screening tool to guide early diagnosis and treatment. This study aims to evaluate the sensitivity of dipstick urinalysis and microscopy in the diagnosis of UTI.Methods:A retrospective review of children aged 16 years and below with positive urine culture (UC) over a 3-year period was done. The results of urine dipstick and microscopy were compared with the positive UC and sensitivities calculated.Results:Dipstick urinalysis and microscopy of 262 children were studied. Female-to -male ratio of 1.8:1. Median age was 0.79 (range: 0.02–15.95) years. The sensitivity of nitrite, blood, and leukocyte esterase (LE) were 0.54, 0.74, and 0.86 (95% confidence interval [CI] = 0.46–0.62, 0.68–0.80, and 0.82–0.91), respectively. The sensitivity of pyuria of ≥100 cells/mm3 was 0.92 (95% CI = 0.89–0.95). The presence of any of the 3 dipstick parameters increased the sensitivity to 0.97 (95% CI = 0.95–0.99). The lowest sensitivity 0.49 (95% CI = 0.40–0.58) was found with combined positive LE and nitrite. There was a significant comparison between positive LE dipstick test and pyuria (P = 0.000004).Conclusions:Dipstick urinalysis may not be reliable in ruling out UTI in children. However, considering both positive dipstick and pyuria will be more useful in making the diagnosis.

The reliability and validity of using the urine dipstick test by patient self-assessment for urinary tract infection screening in spinal cord injury patients.

Aims:The aim of this is to evaluate the reliability of the urine dipstick test by patients’ self-assessment for urinary tract infection (UTI) screening and to determine the validity of urine dipstick test.Settings:Rehabilitation Department, Srinagarind Hospital, Thailand.Study Design:A diagnostic study.Subjects and Methods:This study compared the urine dipstick test (index test) with the National Institute on Disability and Rehabilitation Research (NIDRR) criteria (gold standard test) in spinal cord injury (SCI) patients. The urine dipstick test informed positive and negative results. Besides the NIDRR criteria classified as UTI and no UTI. The interrater reliability was measured in the sense of Kappa whereas the validity of urine dipstick test was reported in terms of sensitivity, specificity, positive likelihood ratio (LR) (+LR), negative LR (−LR), positive predictive value (PPV), and negative predictive value (NPV).Results:Out of the 56 participants, the kappa of urine dipstick test for leukocyte esterase, nitrite, and combined leukocyte esterase and nitrite were 0.09, 0.21, and 0.52, respectively. The nitrite urine dipstick test showed the highest sensitivity (90%). The combined leukocyte esterase and nitrite urine dipstick test gave the highest specificity (87%), PPV (60%), NPV (93%), and +LR (5.63).Conclusions:The interrater reliability of combined leukocyte esterase and nitrite urine dipstick test was moderate agreement. The combined leukocyte esterase and nitrite urine dipstick test showed high level of both sensitivity and specificity. The combined leukocyte esterase and nitrite urine dipstick test should be promoted for patients’ self-assessment for UTI screening in SCI patients.

Leucocyte esterase dip-stick test as a point-of-care diagnostic for urogenital chlamydia in male patients: A multi-center evaluation in two STI outpatient clinics in Paramaribo and Amsterdam.

BackgroundPoint-of-care (POC) tests are an important strategy to address the epidemic of sexually transmitted infections (STIs). The leucocyte esterase test (LET) can be used as a POC test for chlamydia. The aim of this study was to determine the diagnostic accuracy of the LET to detect urogenital chlamydia among men at STI clinics in Paramaribo, Suriname and Amsterdam, the Netherlands.MethodsRecruitment of patients took place in 2008–2010 in Suriname and in 2009–2010 in the Netherlands. Urine of patients was examined with the LET. The reference test was a nucleic acid amplification test (NAAT).ResultsWe included 412 patients in Suriname and 645 in the Netherlands. Prevalence of chlamydia in Suriname and the Netherlands was respectively 22.8 and 13.6 %. The sensitivity of the LET was 92.6 % (95 % CI = 85.3–97.0) and 77.3 % (95 % CI = 67.1–85.5) respectively, the specificity was 38.1 % (95 % CI = 32.7–43.6 %) and 58.1 % (95 % CI = 53.9–62.3) respectively. The positive predictive value was 30.6 % (95 % CI = 27.3–36.4) and 22.6 % (95 % CI = 18.0–27.7) respectively and the negative predictive value was 94.5 % (95 % CI = 89.1–97.8) and 94.2 % (95 % CI = 91.1–96.4) respectively. The kappa was respectively 0.179 and 0.176.ConclusionsTo diagnose urogenital chlamydia in men the LET performs poorly. It has a high negative but low positive predictive value. If the LET result is negative, chlamydia is accurately excluded, yet a positive result has a low predictive value. Whether the advantages of direct management based on LET outweigh the disadvantages of overtreatment is a subject for further studies.

The influence of vitamin C on the urine dipstick tests in the clinical specimens: a multicenter study

Vitamin C may interfere with the results of urine dipstick tests. We investigated the incidence of urinary vitamin C and its interference with urine dipstick reagents using a vitamin C dipstick. The incidence of urinary vitamin C was determined in patients and healthy individuals undergoing routine medical check-ups. Interference tests were performed using samples with various amounts of added vitamin C. For clinical samples, we identified false-negative dipstick glucose, hemoglobin, and leukocyte esterase results based on the urine sediment and serum glucose results. Vitamin C was found in the urine of 18.1% of the subjects overall, and 23.1% of those undergoing medical check-ups. Dipstick results for glucose, leukocyte esterase, and hemoglobin differed between samples without vitamin C and with added vitamin C. When vitamin C was detected in clinical urine samples, 42.3%, 10.6%, and 8.2% of the glucose, hemoglobin, and leukocyte esterase dipstick tests were rated as false negative, respectively. Vitamin C was frequently found in clinical urine samples, and its concentration was higher in individuals undergoing medical check-ups. Urinary vitamin C can interfere with the urine dipstick results. This study gives useful information for predicting false-negative rates of urine dipstick tests caused by vitamin C.

COMPARATION OF EFFECTIVENESS OF NORMAL SALINE AND 10% POVIDONE IODINE IN PERIURETHRAL CLEANING

Currently, urinary tract infection incidence in patients with indwelling urinary catheter ranges between 10-80%. They are at risk for other problems that can cause death. Appropriate action is required to decrease urinary tract infection risk by periurethral area cleaning. The aim of this study is to analyze the differences of the effectiveness of the use of normal saline and 10% povidone iodine for periurethral area cleaning in decreasing urinary tract infection risk. Research methods uses experimental design with the population of patients who used indwelling urinary catheter. Samples were obtained by consecutive and allocation by randomization which were divided into 2 groups, each group were 17 respondents. In the treatment group, periurethral area was cleaned with normal saline and in the control group with 10% povidone iodine. Urinary tract infection risk assessment was carried out by the leukocyte esterase dipstick test at 8 hours after insertion. The results indicate that the incidence of urinary tract infections risk in the group using normal saline smaller than 10% povidone iodine with a comparison of 1:1.3. Number need to treat in this study was 6. The conclusion of this study is normal saline is more effective in reducing urinary tract infection risk.