Positive Urine Dipstick Research Articles

Overuse of antibiotics for urinary tract infections in pregnant refugees, Lebanon.

To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use. We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm. The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48euros per woman. A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.

Comparative Retrospective Assessment of the Effectiveness and Risk Factors of Fluoroquinolones, Cephalosporines, and Selective Antibiotic Prophylaxis for Transrectal Prostate Biopsy

Introduction: Despite increasing resistance of enterobacteria against fluoroquinolones (FLU), they are still widely used during transrectal prostate biopsy (TRPB). This study was designed to analyse infectious complications and risk factors between FLU, cephalosporines (CEPH) and selective other antibiotics (O-AB) used during TRPB. Methods: 664 patients were included retrospectively (152 FLU, 452 CEPH and 60 O-AB). Infectious complications were defined as fever >38.0°C, the in-house definition of complicated urinary tract infection (cUTI) (if all applied: fever >38.0°C, leucocytosis >11.000/µL and positive urine dipstick) or postinterventional bacteriuria. Hospitalisation rate, duration and comorbidities were also assessed. χ2 and Fisher’s exact test were used for group comparison. Multivariate regression analysis assessed the association of comorbidities with infectious complications. Results: FLU and CEPH were indifferent regarding infectious complications, however in the O-AB group significantly more common compared to FLU and CEPH (11.6, 13.3, 25%, p < 0.05). Duration of hospital stay in CEPH was significantly shorter compared to FLU and O-AB (4.1 vs. 6.3 vs. 8.2 days, p < 0.05). Arterial hypertension showed increased association with fever (OR 6.002 (1.178; 30.597) p = 0.031) and cUTI (OR 6.006 (1.207; 29.891) p = 0.029). Conclusion: Infectious complications were low and indifferent between FLU and CEPH but significantly more frequent in O-AB. Arterial hypertension was significantly associated with postinterventional fever and cUTI.

Efficacy of Five Days Nitrofurantoin Therapy versus Fosfomycin Stat Dose in Clinical Resolution of Uncomplicated Urinary Tract Infections

Objective: To compare the efficacy of 5-days Nitrofurantoin therapy versus Fosfomycin stat dose in clinical resolution of uncomplicated urinary tract infections in females of reproductive age group.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2019 to Mar 2020.&#x0D; Methodology: A total of 498 females of reproductive age (18 years to 40 years) with lower urinary tract infection symptoms(increased urinary hesitancy, frequent micturition, tenderness at suprapubic region) and positive urine dipstick test for nitrates/leukocyte esterase test were incorporated in the study. Patients were randomly assigned to Group-A and Group-B,comprising 249 patients. Group-A was given tablet Nitrofurantoin 100mg every six hourly. Group-B was given Fosfomycin 3gstat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tractinfection symptoms and bacteriologic response.&#x0D; Results: Clinical resolution of urinary tract infection on the 28th day of treatment was attained in 172(69.1%) patients of the Nitrofurantoin-Group versus 140(56.2%) patients receiving Fosfomycin (p-value 0.003). Baseline urine cultures were positive in 286(57.4%) patients. Microbiologic resolution was achieved in 109 of 140(77.9%) and 100 of 146(68.4%) (p- value=0.026).&#x0D; Conclusion: Among the females of reproductive age, five days of Nitrofurantoin therapy is superior to stat dose Fosfomycin in the clinical and microbiologic resolution of uncomplicated urinary tract infections.

Acute Kidney Injury and Hemolytic Uremic Syndrome in Severe Pneumococcal Pneumonia—A Retrospective Analysis in Pediatric Intensive Care Unit

Abstract Objectives: This study aimed to evaluate the prevalence of acute kidney injury (AKI) and hemolytic uremic syndrome (HUS) in severe pediatric pneumonia due to Streptococcus pneumoniae and to identify factors associated with AKI and HUS in these patients. Methods: We retrospectively analyzed pediatric patients who were admitted to our pediatric intensive care unit due to severe pneumococcal pneumonia between 2013 and 2019. Results: Forty-two patients with a median age of 4.3 years were included. Among these patients, 14 (33.3%) developed AKI, including seven (16.7%) stage 1, two (4.8%) stage 2, and five (11.9%) stage 3 AKI. Features of HUS were present in all of the patients with stage 3 AKI, and four required renal replacement therapy (RRT), with a median duration of 10.5 days (range 3 to 16 days). All patients with HUS required mechanical ventilation and inotropic supports. Patients with lower leukocyte and platelet counts, serum sodium and bicarbonate levels, positive urine dipstick (heme or protein ≥ 2 + ), and presence of bacteremia were associated with stage 2 and 3 AKI. Conclusions: Pediatricians should be aware of the relatively high prevalence of kidney involvement in severe pneumococcal pneumonia, with one-third having AKI and 11.9% developing HUS. Majority (80%) of HUS patients required RRT. Positive urine dipstick, serum sodium, and bicarbonate at presentation, which can be measured in point-of-care tests, may potentially be useful as quick tests to stratify the risks of moderate-to-severe AKI.

The role of a urine dipstick in the diagnosis of the acute scrotum.

ObjectiveTo evaluate the role of a urine dipstick in the assessment of acute scrotal pain emergency department presentations.MethodsA single institution, prospective case series, from February 2020 to February 2021. All patients who received a bedside review by a urology doctor for acute scrotal pain were included. Urine dipstick results were pre‐defined as having had an impact on the emergency clinician's diagnosis if it showed pyuria and/or nitrituria and the final diagnosis was epididymitis‐orchitis or haematuria and the final diagnosis was ureterolithiasis.Results139 patients presented to the emergency department with a complaint of acute scrotal pain. 85 (61%) were referred for bedside urology review. Median age of 17 years (P25 12 yrs, P75 31 yrs). 2.3% (n = 2) had proven testicular torsion, 28.5% (n = 24) had epididymitis‐orchitis and 8.2% (n = 7) had ureterolithiasis. 68 (80%) of patients received a primary diagnosis of testicular torsion by the emergency department clinician. Following review by a urology unit doctor, 14 proceeded to scrotal exploration for concern of testicular torsion. 7 patients were diagnosed with ureterolithiasis, all of whom had haematuria on their urine dipsticks (100%, 95% CI: 59–100%), 100% of these urine dipsticks were initiated by the urology unit doctor following bedside review. 22 patients were diagnosed with epididymitis‐orchitis. 8 of these had pyuria, nitrituria and/or haematuria on their urine dipstick (36%, 95% CI: 17–59%) and only one urine dipstick was completed prior to referral. 20.6% of patients perceived to have testicular torsion by the emergency department had a positive urine dipstick that aligned with their final alternative diagnosis (95% CI: 12–32%).ConclusionA collection of clinical findings is required to diagnose the aetiology of acute scrotal pain. Information that can be easily, quickly, cheaply, and reliably collected, such as a urine dipstick, can assist in clinical decision making.

The clinical and microbiological efficacy of temocillin versus cefotaxime in adults with febrile urinary tract infection, and its effects on the intestinal microbiota: a randomised multicentre clinical trial in Sweden

Use of third-generation cephalosporins, such as cefotaxime, is associated with an increased risk of selection for antimicrobial resistance, so alternative antibiotics need to be considered. The aim of the present study was to evaluate intestinal colonisation with third-generation cephalosporin-resistant pathogens following use of temocillin-an alternative antibiotic to cefotaxime that is potentially less prone to disturbing the intestinal microbiota-in empirical treatment of febrile urinary tract infection (UTI). We did a randomised, multicentre, superiority, open-label phase 4 trial in patients who had been admitted to inpatient care in 12 Swedish hospitals with suspected or diagnosed febrile UTI (complicated or uncomplicated). To meet inclusion criteria, a patient was required to have at least one sign or symptom of pyelonephritis (ie, flank pain; costovertebral angle tenderness; and changes to urinary frequency or urgency or dysuria), a fever of 38·0°C or higher, and a positive urine dipstick (for nitrites, white blood cells, or both). Participants were also required to have an indication for intravenous antibiotic treatment. Participants were randomly assigned (1:1) to receive either 2 g temocillin or 1-2 g cefotaxime, by local investigators opening consecutive sealed randomisation envelopes that were generated centrally in advance. Both drugs were administered intravenously every 8 h. The trial was open label for investigators and patients, but those doing the microbiological analyses were masked to the groups. Participants were treated with antibiotics for 7-10 days (or up to 14 days if they had bacteraemia), at least 3 days of which were on the study drug; at day 4 and later, participants who were showing improvement could be given an oral antibiotic (ciprofloxacin, ceftibuten, cefixime, or co-trimoxazole). Patients not showing improvement were regarded as having treatment failures. Rectal swabs were collected at three timepoints: at baseline (before the first dose), after the last dose of study drug, and 7-10 days after treatment stopped. The composite primary outcome was colonisation with Enterobacterales with reduced susceptibility to third-generation cephalosporins, or colonisation with toxin-producing Clostridioides difficile, or both, to evaluate disturbance of the intestinal microbiota. The study is registered in the EU Clinical Trials Register (EudraCT 2015-003898-15). Between May 20, 2016, and July 31, 2019, 207 patients were screened for eligibility, of whom 55 patients were excluded. 152 participants were randomly assigned to groups: 77 (51%) patients received temocillin, 75 (49%) patients received cefotaxime. The composite primary endpoint was met by 18 (26%) of 68 participants receiving temocillin versus 30 (48%) of 62 patients receiving cefotaxime (risk difference -22% [95% CI -42% to -3%]), showing superiority of temocillin versus cefotaxime (ie, less disturbance of the intestinal microbiota). 43 adverse events were reported in 40 (52%) of 77 patients in the temocillin group, versus 46 adverse events in 34 (45%) of 75 patients in the cefotaxime group. Most events were of mild to moderate severity. 21 (27%) patients in the temocillin and 17 (23%) patients in the cefotaxime group had an adverse event that was considered to be associated with the study drug. Temocillin was found to be less selective than cefotaxime of Enterobacterales with reduced susceptibility to third-generation cephalosporins, and it could therefore be a favourable alternative in the empirical treatment of febrile UTI. Use of this antibiotic could reduce hospital transmission and health-care-associated infections by these pathogens. Public Health Agency of Sweden.

United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020.

The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.

Enhanced Antibiotic Treatment Based on Positive Urine Dipstick Infection Test Before Percutaneous Nephrolithotomy Did Not Prevent Postoperative Infection in Patients with Negative Urine Culture.

Introduction: Urinary tract infection (UTI) should be treated before percutaneous nephrolithotomy (PCNL). However, the most appropriate treatment strategy in patients with negative urine culture but positive urine dipstick infection test (positive urinary leukocyte or nitrite reaction) remains unclear. Materials and Methods: From August 2016 to February 2018, 806 consecutive patients who had undergone the first-stage PCNL with negative urine culture were included. Preoperative urinalysis, antibiotic treatment, intraoperative stone culture, and postoperative systemic inflammatory response syndrome (SIRS) were prospectively recorded. The primary outcome was SIRS. The impact of preoperative antibiotics on preoperative UTI, stone culture, and postoperative SIRS was studied. Results: Among the 806 participants, the rate of positive urine dipstick infection test and SIRS were 26.8% and 7.2%, respectively. In univariable analysis, positive urinary nitrite (p < 0.001), positive urinary leukocytes (p < 0.001), positive urine dipstick infection test (p < 0.001), longer duration of pre-PCNL antibiotics (p = 0.001), higher level of pre-PCNL antibiotics (p = 0.010), infection stones (p = 0.001), and positive stone culture (p < 0.001) were risk factors for SIRS. However, multivariable analysis showed that positive stone culture (p = 0.004) and prolonged preoperative treatment with antibiotics (p = 0.021) were independent risk factors for SIRS. Although preoperative antibiotics reduced the incidence of positive urine leukocyte (p < 0.001) or nitrite reactions (p < 0.001), prolonged or upgraded preoperative antibiotics did not affect the incidence of positive stone culture. Whether stone culture was positive (p = 0.023) or negative (p = 0.025), prolonged preoperative treatment with antibiotics was associated with a higher incidence of SIRS. Conclusions: Enhanced preoperative antibiotic treatment based on positive urine dipstick infection tests was insufficient to reduce the incidence of positive stone culture but increased the risk of SIRS after PCNL in patients with negative urine cultures.

147 Improving Urine Specimen Collection in Elderly Medical Inpatients—A Quality Improvement Project

Abstract Introduction The National Institute for Health Research reported in 2012 that urinary tract infections are a significant cause of mortality especially among the elderly population with 4,835 deaths in England and Wales. During an elderly care rotation, it was noted that a number of elderly inpatients were being treated for UTIs without urine samples for culture and sensitivity being collected. They were treated with antibiotics largely on the basis of positive urine dipsticks and/or clinical signs and symptoms. Despite local policy reflecting current national guidance on the diagnosis of UTIs in the elderly population, compliance remained poor. Method A quality improvement project using both quantitative and qualitative methodology was designed to determine the number of elderly medical inpatients (≥ 65 years) who have had urine sampling done within 48 hours of presentation as well as to seek to improve this aspect of patient care by determining limiting factors which could prove a hindrance to urine sampling in this age cohort. Quality improvement methods were used to improve and optimise urine sampling rates. Results The percentage of elderly medical inpatients having a urine sample taken on admission during the project period increased from 35% to just under 100%. Quality improvement methods have successfully identified and improved this aspect of the elderly care service leading to better patient care. Conclusion It was identified that lack of awareness and communication from both sides of the medical and care teams contributed to untimely urine sampling at our hospital. Education and personal discussion represents a sustainable intervention which could easily be replicated in other Trusts. Further work is underway with the development of a teaching session to support nurses and clinical support workers obtaining urine samples from incontinent patients undertaken by one of our community continence clinical nurse specialists.

Haemoglobinuria for the early identification of aHUS relapse: data from the ItalKId-HUS Network.

Atypicalhaemolytic uremic syndrome(aHUS) is at high risk of relapse at any time, therefore patients require lifelong monitoring. The most appropriate way to monitor patientsis not yet clear. Patients could be monitored for relapse by urine dipstick testing for haemoglobinuria based on thehypothesisthat thrombotic microangiopathy involving the glomerulus and associated with renal damage (like aHUS) cannot occur without haematuria. The aim of this retrospective study is to analyse our experience with this approach in aHUS patients who have never previously been treated, who are currently on treatment or who have discontinued C5 inhibition.The records of all aHUS patients (children and adults) managed by or referred to our Centre from January 2009 to March 2020 were included and the analysisfor the presence of haemoglobinuriawas restricted to the period followingprimary remission. A positive test was defined as haemoglobin ≥ 1 + .Patients reporting positive urine dipstick tests underwent laboratory investigations to rule in or out the diagnosis of aHUS relapse. Eighty-four patients were included with 1517 determinations of haemoglobinuria during a cumulative observation period of 8904 patient-months. Haemoglobinuria for the early diagnosis of ongoing aHUS relapse shows a sensitivity of 100% and a specificity of 87.4% with a positive predictive value (PPV) of 10.5% and a negative predictive value (NPV) of100%. The accuracy of the test was 87.6%. Haemoglobinuria is a very sensitive and acceptably specific marker of aHUS relapse. This finding and its validation may have a positive impact on patients' quality of life and on the outcome of this life threatening disease via early diagnosis of relapse.

The prevalence of positive urine dipstick testing and urine culture in the asymptomatic pregnant woman: A cross-sectional study

ObjectivePregnancy induces unique physiological changes to the urinary tract, leaving pregnant women more susceptible to pyelonephritis. Urinary tract infections are generally diagnosed using urine sampling and testing with reagent sticks (dipstick) or laboratory culture. This study aimed to establish the prevalence of positive urine reagent strip and urine culture in asymptomatic pregnant women. Study designThis was a cross-sectional study of 300 women attending routine antenatal clinics. Samples were analysed using an automated urine dipstick analyser for the presence of glucose, protein, leucocyte esterase, blood, and nitrites. All samples were cultured. Multinomial logistic regression was performed to investigate risk factors for urine contamination and infection. Sensitivities and specificities were calculated for common dipstick findings for positive and mixed urine culture. ResultsOne-in-three (37.0 % [111/300], 95 % CI 31.6–42.8 %) women had at least one positive finding on reagent strip testing. Ten per cent ([29/300], 95 % CI 6.7–13.7 %) of samples had a positive culture for a single organism, whereas 46.7 % ([140/300], 95 % CI 40.9–52.5 %) of samples were positive for multiple organisms (mixed culture). 43.7 % ([131/300], 95 % CI 38.0–49.5 %) of samples had a negative culture. Organisms cultured were similar to previous reports from high-income countries. BMI was identified on regression analysis as a risk factor for contamination. ConclusionsThere is a high prevalence of positive urine dipstick and contaminated culture in asymptomatic pregnant women. BMI is a risk factor for urine culture contamination and further research into this topic is essential given trends in obesity worldwide.

Abstract A33: Intratissutal and urinary microbiome in therapy-naive bladder cancer patients: Definition of a gender-specific common microbiome

Abstract Background: Despite being actively investigated for several other malignancies, the impact of the microbiome on tumorigenesis, response to therapy, and patient outcomes has not been thoroughly assessed in urothelial bladder cancer (BCa). Of note, the relationship between urinary and bladder tissue microbiomes has not yet been investigated. Herein, we aimed to assess: i) the gender-specific microbiome differences in the urine and bladder tissue; ii) the extent to which paired urine samples mirror the bladder tissue-associated microbiome. Methods: A total of 166 biologic samples were analyzed: morning, mid-stream voided urines from 49 therapy-naïve patients (36 males, 13 females) undergoing radical cystectomy for MIBC and from 59 age-matched healthy controls (34 males, 25 females), plus bladder tissue specimens (paired BCa/non-BCa tissues) of 29 patients (21 males, 8 females). Exclusion criteria included history of recurrent urinary tract infections, positive urine dipstick test at the time of sample collection, recent antibiotic therapy, history of intravesical or neoadjuvant treatment for BCa. Microbiome was analyzed by amplicon-based approach. Sequences with a high-quality score &amp;gt;Q30 and length &amp;gt;250bp were used for the taxonomic analysis and were processed using the QIIME (Quantitative Insights Into Microbial Ecology) software package (v1.9.1). Intra- and interdiversity between samples and identification of taxonomic biomarkers by using the linear discriminant analysis (LDA) effect size (LEfSe) were considered significant at p-value ≤0.05. Results: Comparing neoplastic vs. non-neoplastic paired tissues, beta-diversity did not show distinct clustering of the samples. At the taxonomic level, the genus Burkholderia was enriched in the neoplastic specimens in both genders. When we compared urines of patients vs. controls, the male and female urinary microbiome was dominated by members of the three major bacterial phyla Proteobacteria, Firmicutes, and Bacteroidetes. At lower taxonomic levels, the bacterial taxa differently enriched in BCa vs. controls were gender-specific, with 18 and 36 bacterial taxa differentially represented in BCa and controls in men and women, respectively. Comparing paired urinary and tissue-associated microbiome, we defined the “common BCa microbiome,” representing 34 and 16 bacterial families (&amp;gt;80% of total relative abundance) shared in the urines and tissues of male and female patients, respectively. Conclusions: We provide novel characterization of the gender-specific microbiome in the urines and paired bladder tissues of BCa patients. A gender-specific “common BCa microbiome” was detailed, highlighting potentially actionable bacterial taxa. Citation Format: Filippo Pederzoli, Roberto Ferrarese, Virginia Amato, Irene Locatelli, Elisa Alchera, Roberta Lucianò, Manuela Nebuloni, Alberto Briganti, Andrea Gallina, Valentina Murdica, Renzo Colombo, Andrea Necchi, Massimo Clementi, Francesco Montorsi, Nicasio Mancini, Andrea Salonia, Massimo Alfano. Intratissutal and urinary microbiome in therapy-naive bladder cancer patients: Definition of a gender-specific common microbiome [abstract]. In: Proceedings of the AACR Special Conference on the Microbiome, Viruses, and Cancer; 2020 Feb 21-24; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2020;80(8 Suppl):Abstract nr A33.

A positive nitrite test was an independent risk factor for invasive bacterial infections in infants under 90days of age with fever without source.

This study analysed the association between a positive nitrite dipstick test and an invasive bacterial infection (IBI) in infants younger than 90days of age with fever without source (FWS). We performed a secondary analysis of data from a prospective multicentre study of infants up to 90days of age with FWS undergoing care in 19 paediatric EDs between October 2011 and September 2013. Invasive bacterial infection was defined as a positive blood or cerebrospinal fluid culture. The dipstick urinalysis was positive for nitrite or leucocyte esterase in 766 (22.5%) of the 3401 infants we studied, and 270 (35.2%) had a dipstick test that was just positive for nitrite. Overall, 107 were diagnosed with an IBI (3.1%). The IBI prevalence was 2.2% among patients with a normal urine dipstick, 4.4% if they had positive leucocyte esterase test results, 8.3% where the nitrite test was positive and 10.6% when both tests were positive. After multivariate analysis, a positive nitrite test remained an independent risk factor for IBI (odds ratio 2.7, 95% confidence interval 1.4-4.9). In infants under 90days of age with FWS, a positive nitrite urine dipstick test was an independent risk factor for IBI.

The management of urinary tract infections in a district general hospital – a closed loop service review and comparison with SIGN guidelines

Elderly patients with new onset of confusion or being ‘off legs’ is a common presenting complaint on the acute take. Urinary tract infections (UTI) are common in the elderly population, often a diagnosis is made based on a positive urine dipstick in the absence of urinary symptoms. However, these patients may actually have asymptomatic bacteriuria (AB). The prevalence of AB in institutionalised women above the age of 65 have been reported to be as high as 57%.1 Bacteriuria is not a disease, and treating it is not advised under the Scottish Intercollegiate Guidelines Network (SIGN) guidelines.2 We looked …

Biomarkers for diagnosing serious bacterial infections in older outpatients: a systematic review

BackgroundThe value of biomarkers for diagnosing bacterial infections in older outpatients is uncertain and limited official guidance exists for clinicians in this area. The aim of this review is to critically appraise and evaluate biomarkers for diagnosing bacterial infections in older adults (aged 65 years and above).MethodsWe searched Medline, Embase, Web of Science and the Cochrane Library, from inception to January 2018. We included studies assessing the diagnostic accuracy of blood, urinary, and salivary biomarkers in diagnosing bacterial infections in older adults. The QUADAS-2 tool was used to assess study quality.ResultsWe identified 11 eligible studies of moderate quality (11,034 participants) including 51 biomarkers at varying thresholds for diagnosing bacterial infections. An elevated Procalcitonin (≥ 0.2 ng/mL) may help diagnose bacteraemia in older adults [+ve LR range 1.50 to 2.60]. A CRP ≥ 50 mg/L only raises the probability of bacteraemia by 5%. A positive urine dipstick aids diagnosis of UTI (+ve LR range 1.23 to 54.90), and absence helps rule out UTI (−ve LR range 0.06 to 0.46). An elevated white blood cell count is unhelpful in diagnosing intra-abdominal infections (+ve LR range 0.75 to 2.62), but may aid differentiation of bacterial infection from other acute illness (+ve LR range 2.14 to 7.12).ConclusionsThe limited available evidence suggests that many diagnostic tests useful in younger patients, do not help to diagnose bacterial infections in older adults. Further evidence from high quality studies is urgently needed to guide clinical practice. Until then, symptoms and signs remain the mainstay of diagnosis in community based populations.

Présentation clinique et performance de la bandelette urinaire pour le diagnostic d’infection urinaire en population gériatrique

BackgroundUrinary tract infections (UTI) are the second cause of community-acquired bacterial infections in the elderly. Distinguishing symptomatic UTI from asymptomatic bacteriuria is problematic, as older adults are less likely to present with localized urinary symptoms. We evaluated characteristics of patients presenting UTI among elderly with sepsis. Moreover, we aimed to evaluate the sensibility and specificity of urine dipstick tests in the diagnosis of UTI in geriatric population. Patients and methodWe led a prospective, monocentric, observational study between April 2017 and January 2018. We included patients hospitalized in geriatric wards, who were prescribed urine culture for UTI symptoms or/and infection without primary sites for which a urine culture was prescribed. Dipstick urinalyses were performed for all patients.Clinical and biological characteristics of all patients were compared according to the final diagnosis of UTI. Moreover, results of dipstick tests were evaluated for the diagnosis of UTI in this population. ResultsAmong 165 patients, 67 (40.6 %) had a UTI and 98 (59.4 %) had another diagnosis. These two groups were comparable for age and daily-living activities. In the UTI group, the proportion of women was higher than in the other group (P<0.05), and mean MMSE score was lower (P<0.05).Positive urine dipstick test for leukocytes and/or nitrites had high sensitivity (92 %), but low specificity (50 %). Negative predictive value of this test was high (91 %). ConclusionFor suspicion of UTI among elderly, few criteria are specific. Negative dipstick tests can suggest an absence of UTI due to its high negative predictive value.

Screening for Microscopic Hematuria in a Urogynecologic Population

The objectives of this were to determine the correlation of greater than or equal to 3 red blood cells per high-power field (RBCs/HPF) with a positive urine dipstick for blood and to identify clinically relevant factors than can influence this relationship. The charts of women with positive blood urine dipsticks were reviewed from August 2012 to August 2013. The cohort of women was divided into 2 groups; those with urine with greater than or equal to 3 RBCs/HPF on microscopy and those without. Relevant clinical and demographic variables were extracted from the electronic medical record. Data analysis was conducted using SAS version 9.4 (SAS Institute, Cary, NC). Most of the 203 patients eligible for analysis were Caucasian, and the total cohort had a mean age of approximately 62.8 years. Microscopy confirmed greater than or equal to 3 RBCs/HPF in 25.6% of the urine samples. A dipstick finding of moderate or large blood was significantly more likely to have greater than or equal to 3 RBCs/HPF on univariate and multivariable analyses (P < 0.001). Factors significantly associated with greater than or equal to 3 RBCs/HPF were increasing age, recurrent urinary tract infections, and urinary specific gravity of greater than 1.010. Lower urinary specific gravities appear to be associated with underestimating microhematuria, likely owing to the underrepresentation of the true number of red blood cells. Urine dipstick indicators of moderate or large blood increase the likelihood the microscopy samples demonstrated greater than or equal to 3 RBCs/HPF. These findings suggest that clarification of microhematuria detection and evaluation guidelines should be considered, given both important clinical and economic consequences.

Uropathogens and their Susceptibility to Common Antibiotics in Adult Patients Presenting to the Emergency Department of a Tertiary Care Hospital in Pakistan

OBJECTIVE To identify the prevalence of uropathogens and their susceptibility patterns to different antibiotics in adult patients presenting to the emergency department with lower urinary tract symptoms so that treating physicians can identify common pathogens and select a reasonable empirical antibiotic if needed. METHODOLOGY The study is a retrospective chart review conducted in the emergency department of Shifa International Hospital, Islamabad, Pakistan. All the patients diagnosed with urinary tract infection through dipstick in the emergency department whose urine cultures were positive were included in the study. The chart review was done from January 1st, 2018 to 31st December 2018. RESULTS Out of 203 patients with positive urine dipstick, whose cultures sent from emergency only 64(31.3%) samples showed significant bacterial yield. Most patients included in the study were above 50 years of age (79.7%) with a male predominance (males 36, females 28). The most common organisms isolated was E.coli 44 (68.8%) followed by Klebsiella spp. 09(14%) and Enterococcus spp. 03 (4.7 %) respectively. Antibiotics which were found most sensitive against pathogens in our study included Imipenem (78.1 %), Nitrofurantoin (76.6 %) and Fosfomycin (76.6 %) respectively. On the other hand most of microbial growth was highly resistant to both penicillins (Co-amoxiclave 80.8 %) and cephalosporin (Cefixime 84.4%, Ceftazidime 78.1 %, and Ceftriaxone 81.2 %). Moderately resistance was seen to antibiotics such as Co-Trimoxazole (71.4%), Ciprofloxacin (73.4%) and Gentamicin (48.4%) respectively. A high prevalence of carbapenem resistance (9.4% to imipenem) was also observed in this study CONCLUSION Most uropathogens identified in patients presenting to the emergency department with urinary complains are sensitive to Fosfomycin, Nitrofurantoin, Gentamycin, and Imipenem which may be considered as empirical therapy in our settings.

Predictors of Symptom Duration and Bacteriuria in Uncomplicated Urinary Tract Infection

Objective: To identify baseline predictors of symptom duration after empirical treatment for uncomplicated urinary tract infection (UTI) and significant bacteriuria in a cohort of women treated for UTI.Design: Prospective single-centre cohort study.Setting: Outpatient clinic in Norway.Patients: From September 2010 to November 2011, 441 women aged 16–55 years with symptoms of uncomplicated UTI were included.Results: Dipstick findings of leukocyte esterase 1 + (incidence rate ratio (IRR) 1.93, 95% confidence interval (CI) 1.23–3.01, p < 0.01) and microbe resistant to mecillinam treatment (IRR 1.41, 95% CI 1.07–1.89, p = 0.02) predicted longer symptom duration. More pronounced symptoms did not predict longer symptom duration (IRR 1.18, 95% CI 0.94–1.46, p = 0.15) or significant bacteriuria (odds ratio [OR] 1.16, 95% CI 0.72–1.88, p = 0.54). Leukocyte esterase 2 + (OR 2.51, 95% CI 0.92–6.83, p = 0.07) or 3 + (OR 2.40, 95% CI 0.88–6.05, p = 0.09) and nitrite positive urine dipstick test (OR 3.22, 95% CI 1.58–7.01, p = <0.01) were associated with bacteriuria.Conclusion: More pronounced symptoms did not correlate with significant bacteriuria or symptom duration after empirical treatment for acute cystitis. One might reconsider the current practice of treating uncomplicated UTI based on symptoms alone.Key PointsTreatment strategies for milder infectious diseases must consider ways of reducing antibiotic consumption to decelerate the increase in antibiotic resistance. Our findings suggest that more emphasis should be put on urine dipstick results and bacteriological findings in the clinical setting. One might reconsider the current practice of treating uncomplicated UTIs based on symptoms alone.

Cleaning the genitalia with plain water improves accuracy of urine dipstick in childhood.

Cleaning the genital area with plain water should always be performed before collecting urine samples, even if only a urine dipstick without culture is needed. What is Known: • Cleaning the genital area reduces the urine bacterial contamination rate in populations of toilet-trained pediatric patients. • There are no studies assessing the impact of cleaning the genital area on the quality of the urine dipstick, nor on which factors could affect the urine dipstick findings. What is New: • Falsely positive urine dipstick was found in 25.5% of the 612 prospectively enrolled toilet-trained and not-toilet-trained children. • Non-retractable foreskin and female gender significantly increases the relative risk of falsely positive urine dipsticks.