Diagnostic Accuracy of Urine Analysis (DR) in Suspicious Cases of Urinary Tract Infections by Taking Urine Culture as Gold Standard

2021 ◽  
Vol 15 (12) ◽  
pp. 3494-3497
Author(s):  
Akhtar Ali ◽  
Shahzad Ali ◽  
Naresh Kumar Valecha ◽  
Saeed Ahmed Khan

Background: Urinary tract infections (UTI) are one of common clinical condition encountered in various clinical settings. This the most common infection, typically diagnosed on the basis history and clinical examination endorsed by urine analysis and culture sensitivity. Timely diagnosis and treatment are crucial in management. For diagnosis of UTI, Urine culture is standard, as it provide detail information for urinary pathogens, but it has certain disadvantages e.g. urine culture is costly, takes longer time, and up to 60-80% of the results are negative. Objective: To determine the diagnostic accuracy of urinalysis (Urine DR) in detection of urinary tract infection (UTI) among suspected cases of UTI by taking urine culture as gold standard. Materials And Methods: This cross sectional study was conducted at study was conducted at Department of Urology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from march 2021 to September 2021. All patients who visited to JPMC Karachi and fulfilled the inclusion criteria and were included in the study after getting Informed consent. All patients were evaluated by urinalysis and urine culture. The results of urinalyses were recorded and compared with the results obtained on subsequent urine cultures. All of the specimens were obtained by the “clean-catch” method. All data and results were recorded on proforma and used electronically for research purpose. Results: Mean ± SD of age was 52.6±8.5 years. In distribution of gender, 60 (53.1%) patients were male while 53 (46.9%) were female patients. Diagnostic accuracy of urinalysis was 73.45% in diagnosis of urinary tract infection with sensitivity 76.47%, specificity 72.15% PPV 54.17% and NPV was found to be 87.69% by using urine culture findings as gold standard. Conclusion: It is to be concluded that evaluating of urinary tract infection (UTI) with urinalysis (Urine DR) did not prove helpful and comparable to urine culture. Urine culture should be done in each and every suspected case of UTI. Keywords: Bacteriuria, Diagnostic Accuracy, Sensitivity, Specificity, Urinalysis

2018 ◽  
pp. 100-108
Author(s):  
Dinh Khanh Le ◽  
Dinh Dam Le ◽  
Khoa Hung Nguyen ◽  
Xuan My Nguyen ◽  
Minh Nhat Vo ◽  
...  

Objectives: To investigate clinical characteristics, bacterial characteristics, drug resistance status in patients with urinary tract infections treated at Department of Urology, Hue University Hospital. Materials and Method: The study was conducted in 474 patients with urological disease treated at Department of Urology, Hue Universiry Hospital from July 2017 to April 2018. Urine culture was done in the patients with urine > 25 Leu/ul who have symptoms of urinary tract disease or infection symptoms. Patients with positive urine cultures were analyzed for clinical and bacterial characteristics. Results: 187/474 (39.5%) patients had symptoms associated with urinary tract infections. 85/474 (17.9%) patients were diagnosed with urinary tract infection. The positive urine culture rate was 45.5%. Symptoms of UTI were varied, and no prominent symptoms. E. coli accounts for the highest proportion (46.67%), followed by, Staphycoccus aureus (10.67%), Pseudomonas aeruginsa (8,0%), Streptococcus faecali and Proteus (2.67%). ESBL - producing E. coli was 69.23%, ESBL producing Enterobacter spp was 33.33%. Gram-negative bacteria are susceptible to meropenem, imipenem, amikacin while gram positive are vancomycin-sensitive. Conclusions: Clinical manifestations of urinary tract infections varied and its typical symptoms are unclear. E.coli is a common bacterium (46.67%). Isolated bacteria have a high rate of resistance to some common antibiotics especially the third generation cephalosporins and quinolones. Most bacteria are resistant to multiple antibiotics at the same time. Gram (+) bacteria are susceptible to vancomycin, and gram (-) bacteria are susceptible to cefoxitin, amikacin, and carbapenem. Key words: urinary tract infection


2021 ◽  
Vol 8 (10) ◽  
pp. 522-526
Author(s):  
Bhavani Shankar Rokkam ◽  
Chowdary Babu Menni ◽  
Ramu Pedada ◽  
Deepak Kumar Alikana

BACKGROUND Urinary tract infections (UTI) constitute a common cause of morbidity in infants and children. When associated with abnormalities of urinary tract, they may lead to long-term complications including renal scarring, loss of function and hypertension. Most urinary tract infections remain undiagnosed if investigations are not routinely performed to detect them. Prompt detection and treatment of urinary tract infections and any complicating factors are important. The objective of the study is to know the clinical, epidemiological and bacteriological profile (i.e. clinical signs and symptoms, age, sex, family history, associated urinary tract abnormalities, & causative organisms) of urinary tract infections in febrile children with culture positive urinary tract infection. METHODS This descriptive, cross sectional observational study was conducted at outpatient clinics of our “child health clinics” between May 2016 and April 2017 (one year). All children aged 0 to 12 years with culture positive urinary tract infections were included in this study to evaluate the clinical, epidemiological and bacteriological profile. RESULTS A total of 69 children with culture positive urinary tract infections were included in this study. Out of 69 children included in this study, 36 (52.2 %) were females and 33 (47.8 %) were males. Overall female preponderance was seen and the M: F ratio was 0.9:1. But during first year of life in our study group we had more boys (10, 14.49 %) affected with urinary tract infection than girls. 49.3 % of urinary tract infections in the present study belonged to lower socio-economic status. Most common organism causing urinary tract infection in our group was E. coli (56.5 %). Fever (100 %), anorexia or refusal of feeds (52.2 %), dysuria (46.4 %), vomiting (46.4 %) and abdominal pain (39.1 %) were the predominant clinical manifestations observed in our study. CONCLUSIONS Urinary tract infection is a common medical problem in children and it should be considered as a potential cause of fever in children. As febrile children with urinary tract infection usually present with non-specific signs and symptoms, urine culture should be considered as a part of diagnostic evaluation. KEYWORDS Urinary Tract Infections (UTI), Febrile Children, Bacteriological Profile, Urine Culture


Open Medicine ◽  
2013 ◽  
Vol 8 (5) ◽  
pp. 597-599 ◽  
Author(s):  
Tsuneaki Kenzaka ◽  
Ayako Kumabe ◽  
Yuka Urushibara ◽  
Kensuke Minami ◽  
Takeshi Ishida

AbstractA 93-year-old woman with neurogenic bladder was admitted to our hospital because of impaired consciousness. Her urine culture revealed urease-test-positive Corynebacterium urealyticum. She was diagnosed with hyperammonemia due to an obstructive urinary tract infection that was caused by urease-producing bacteria. The patient showed rapid improvement of impaired consciousness and hyperammonemia after urine analysis. It is necessary to consider obstructive urinary tract infection as a differential diagnosis of hyperammonemia, which commonly occurs in urinary tract infections owing to the presence of urease-producing bacteria. Relief from obstruction is the most important treatment for hyperammonemia caused by this mechanism.


2021 ◽  
Vol 9 (2) ◽  
pp. 131-137
Author(s):  
Putra Rahmadea Utami

 Urinary tract infection (UTI) is the second largest infection after respiratory infection and can cause sepsis. Urinary tract infections occur due to the entry of microorganisms in the urinary tract. The urinary tract that is usually infected is the urethra (urethritis), bladder (cystisis), ureter (ureteristis), kidney tissue (pyelonephritis). This study aims to determine the sensitivity and specificity of the diagnostic test of nitrite examination with urine culture in suspected urinary tract infections. The method of this study is a descriptive-analytical study with a cross-sectional retrospective approach, conducted in the STIKes field laboratory with the population studied in this study were all patients diagnosed with urinary tract infection with a sample size of 50 samples. The results of this study showed positive nitrite results as many as 17 people, 34% percentage, and negative nitrite results as many as 33 people with a percentage of 66% and on urine culture examination obtained positive results as many as 17 people with a percentage of 34%, which results in growth of bacterial colonies on cultures> 100,000 CFU / mL and negative results of 33 people with a percentage of 66%. Sensitivity Results 82%, Specificity 90.9%. The conclusion of this study is the value of sensitivity, high specificity so that the nitrite test with urine culture can be applied to help diagnose UTI.


PEDIATRICS ◽  
1974 ◽  
Vol 53 (2) ◽  
pp. 289-289
Author(s):  
Thomas F. Dolan ◽  
Alan Meyers

We agree that follow-up urine culture should be obtained after the diagnosis of a urinary tract infection is made. The frequency with which such cultures are obtained is, however, debatable. Our questionnaire did not include this aspect of management. Since 59% of family practitioners and 45% of pediatricians diagnosed urinary tract infections without benefit of culture on a routine basis, it would seem likely that follow-up urine cultures are not performed with regularity. We would join with Dr. Browning in urging careful follow-up and evaluation for children with documented urinary tract infections.


2020 ◽  
Vol 3 (3) ◽  
pp. 226-227
Author(s):  
Atif Abdulhamid Katib ◽  
Omar Shaikhomar ◽  
Mazen Dajam ◽  
Laila Alqurashi

Background: The case we are presenting is about one of the rare pathogens, Serratia Fonticola (SF) that may cause urinary tract infection.  Case Presentation: A 58 years-old female presented with dysuria, suprapubic pain, frequency of micturition, and change in urine color. The patient was afebrile on physical examination; however, the urine culture was positive to SF as the sole isolate. The patient received levofloxacin tables (750 mg) once a day for 5 days along with supportive instructions to improve hygiene. On follow-up, she was free of symptoms and the repeated urine culture was negative.   References Geerlings SE. Clinical presentations and epidemiology of urinary tract infections. Microbiol. Spectr. 4, 2016. https://doi.org/10.1128/9781555817404.ch2 Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May;13(5):269-84. https://doi.org/10.1038/nrmicro3432 Gavini F, Ferragut C, Izard D, Trinel PA, Leclerc H, Lefebvre B, Mossel DA. Serratia fonticola, a new species from water. International Journal of Systematic and Evolutionary Microbiology. 1979;29(2):92-101. https://doi.org/10.1099/00207713-29-2-92 Aljorayid A, Viau R, Castellino L, Jump RL. Serratia fonticola, pathogen or bystander? A case series and review of the literature. IDCases. 2016 May 24; 5:6-8. https://doi.org/10.1016/j.idcr.2016.05.003 Müller HE. Isolation of Serratia fonticola from birds. Zentralblatt Bakteriol Mikrobiol Und Hyg - Abt 1 Orig A 1986; 261:212–8. https://doi.org/10.1016/s0176-6724(86)80038-4 Garcia ME, Lanzarot P, Costas E, Lopez Rodas V, Marín M, Blanco JL. Isolation of Serratia fonticola from skin lesions in a Nile Crocodile (Crocodylus niloticus) with an associated septicaemia. Vet J. 2008 May;176(2):254-6. https://doi.org/10.1016/j.tvjl.2007.02.025. Bollet C, Gainnier M, Sainty JM, Orhesser P, De Micco P. Serratia Fonticola isolated from a leg abscess. J Clin Microbiol 1991; 29:834–5. https://doi.org/10.1128/JCM.29.4.834-835.1991 Farmer JJ 3rd, Davis BR, Hickman-Brenner FW, McWhorter A, Huntley-Carter GP, Asbury MA, Riddle C, Wathen-Grady HG, Elias C, Fanning GR, et al. Biochemical identification of new species and biogroups of Enterobacteriaceae isolated from clinical specimens. J Clin Microbiol. 1985 Jan;21(1):46-76. https://doi.org/10.1128/JCM.21.1.46-76.1985 Stock I, Burak S, Sherwood KJ, Gruger T, Wiedemann B. Natural antimicrobial susceptibilities of strains of 'unusual' Serratia species: S. ficaria, S. fonticola, S. odorifera, S. plymuthica and S. rubidaea. J Antimicrob Chemother. 2003;51(4):865-85. https://doi.org/10.1093/jac/dkg156. Gorret J, Chevalier J, Gaschet A, Fraisse B, Violas P, Chapuis M, Anne JG. Childhood delayed septic arthritis of the knee caused by Serratia fonticola. Knee 2009; 16 (6):512–4. https://doi.org/10.1016/j.knee.2009.02.008 Hai PD, Hoa LTV, Tot NH, Phuong LL, Quang VV, Thuyet BT, Son PN. First report of biliary tract infection caused by multidrug-resistant Serratia fonticola. New Microbes New Infect. 2020; 36:100692. https://doi.org/10.1016/j.nmni.2020.100692 Conclusion: This case can be considered globally the third that diagnosed in the urine culture of the asymptomatic patient.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
EIY Madela ◽  
Alain Assounga

Abstract Background and Aims Urinary tract infection is among the most common causes of sepsis presenting in hospitals. The aim was to collect data to enable empirical treatment of urinary tract infections in HIV negative and positive nephrology patients while waiting for urine culture results in order to reduce hospital stay. Our aim is also to assess incidence and antimicrobial susceptibility of urinary tract infections in HIV negative and positive patients. Method A retrospective chart review of nephrology patients admitted from January to December 2014 in Nephrology ward and the first consecutive 200 outpatients seen in Nephrology clinic in 2014 at Inkosi Albert Luthuli Central Hospital was conducted. Information was gathered with the use of a data collection sheet and urinary tract infection was based on urine culture results. All data was analysed using Statistical Package for Social Sciences version 23. Percentages of basic characteristics were calculated between groups. Logistic regression analysis was used to identify factors associated with positive urine culture. Results There were 654 patients in the study, 514 (79%) were HIV negative and 139 (21%) were HIV positive. The incidence of UTI in nephrology patients was 9%, 10.1% in inpatients and 6.5% in outpatients. 22% were HIV positive (p value 0.883, 95% CI 0.550-2.003). 19% had Diabetes mellitus, 15% had Systemic Lupus Erythematosus and 5% were post renal transplant patients. Escherichia coli and Klebsiella pneumonia were the common causes of urinary tract infection at 40.7% and 15.3% respectively with 22% cases on extended beta lactam resistance. Conclusion There was no statistically significant difference on the incidence and anti-microbial isolates between HIV infected and HIV negative nephrology patients with urinary tract infection. Hence, empirical treatment for UTI should remain the same in the 2 groups. Escherichia coli and Klebsiella pneumoniae were the most commonly cultured organisms in both groups. There is microbial resistance to commonly used antibiotics. Constant assessment of anti-microbial sensitivity of urinary tract infections is of paramount importance.


CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S67-S68
Author(s):  
N. Walji ◽  
A. Greer ◽  
M. Hewitt ◽  
M. BinKharfi

Background: The diagnosis of urinary tract infection (UTI) is made based on symptoms, urinalysis and urine culture. While simple urinary tract infections do not require routine culture, the Infectious Disease Society of America (IDSA) Guidelines state that complicated urinary tract infections should have urine cultures performed to determine which antibiotics are effective, as there is a higher risk of infection with resistant organisms. We hypothesized that the rate of urine cultures sent for complicated UTI is less than is recommended by the literature. Aim Statement: We aimed to implement a follow-up reporting system for Urinary Culture in patients diagnosed with complicated UTIs and raise our Urinary Culture rates in this population to 80% by June 2019. Measures & Design: We performed a single-center chart review using Emergency Department (ED) charts of non-admitted patients. They were audited daily for two weeks to obtain a sample of patients who had a discharge diagnosis of urinary tract infection, pyelonephritis or cystitis. Charts capturing these diagnoses were assessed to see if a culture was clinically indicated and if it was ordered. Charts were screened for the presence of any of the following criteria indicating complicated UTI: known structural or functional abnormality of the urinary tract, genitourinary obstruction, pregnancy, immunosuppression, diabetes, indwelling or intermittent catheter use, fever, male patient, clinical pyelonephritis, antimicrobial failure, or transfer from a nursing home. Data was then compiled to determine culture rates in complicated and uncomplicated UTIs. This prevalence rate established the baseline performance in the ED which was used to inform the quality improvement project. Evaluation/Results: Over a two week period, 26 patients were discharged from the ED with a diagnosis of UTI, with 17 of these patients meeting criteria for complicated UTI. Only 6 of 17 complicated UTIs were sent for urine culture, therefore our pre-implementation culture rate was 35%. After initial data collection, a follow-up system was designed ensuring that urine culture and sensitivities results would be compiled and reviewed daily at Hamilton Health Sciences. This system was created with input from key stakeholders including department chiefs, core lab services, ED physicians and business clerks. A discrepancy form was created for documentation of culture result recognition and any required patient follow up ie. antibiotic change. In October 2019, the system had been implemented for a month, after which another chart review was completed. 27 cases were captured, 18 of which were complicated. The complicated culture rate had increased significantly from 35% to 72%. Discussion/Impact: In the ED, ordering of cultures for patients being discharged, regardless of type, is commonly associated with concern of result follow up, which may take up to 72 hours. This discrepancy system was implemented to ensure that all urine cultures ordered had appropriate follow up, thus supporting physicians in ordering cultures when indicated. The significant improvement in culture rate from 35% to 72% is balanced by one single culture of all 9 simple UTIs (11%). In PDSA cycle 2, we hope to increase rates to 90% by improving current challenges with the system.


Author(s):  
Плеханов ◽  
Aleksandr Plekhanov ◽  
Дамбаев ◽  
Arsalan Dambaev

Urinary tract infections are one of the most common inflammatory disorders of urinary tract that occurs in 40 % of all cases of nosocomial infections. This pathology more often occurs in women, 50 % of them have urinary tract infection at least once in a lifetime. Urinary tract infections are chronic, pluricausal and frequently recurrent diseases. During many decades E. coli was considered to be main pathogenetic flora plated from urine at the urinary tract. Statistically Proteus mirabilis is ranked number two in the degree of incidence. At the moment the researches pay closer attention to Candida pathogens. Urinary tract infections appear in consequence of ingress of microorganisms in urinoexcretory system by ascending, hematogenic and lymphogenic ways. Culture-based, microbiologic study of urine with pathogen isolation and estimation of the bacteriuria degree is the gold standard of diagnostics of urinary tract infections.


2020 ◽  
Vol 27 (07) ◽  
pp. 1428-1432
Author(s):  
Malik Abid Ali ◽  
Muhammad Ahsan ◽  
Arslan Ahmad ◽  
Muhammad Shamaoon ◽  
Tehmina Maqbool ◽  
...  

For children below age of five urinary tract infection (UTI) is the foremost common sources of infection. To lessen the danger of renal scarring it is critical to have immediate diagnosis and treatment. Quick, cost-effective, methods for the analysis of UTI are needed as substitute to culture. Objectives: To determine the diagnostic accuracy of urine dipstick in detection of UTI in children keeping urine culture as a gold standard. Study Design: Cross sectional validation study. Setting: Outpatient Department, Madinah Teaching Hospital, Faisalabad. Period: 01-2018 to 07-2018. Material & Methods: After taking permission from the hospital ethical committee all female patients with urinary tract infection were included. A rapid dipstick analysis for leukocyte esterase and nitrite was done by a staff nurse using Meditest Combi 10 SGL. The reaction of dipstick strip was read visually by a trained nurse who has five year experience working in the Outpatient Department, Madinah Teaching Hospital, Faisalabad. All dipstick positive and dipstick negative samples underwent cultures by sending samples in a clean container to the pathology lab via a sanitary attendant within one hour of the urine collection. Results: In our study, 69.21%(n=281) were between 2 months to 3 years of age while 30.79%(n=125) were between 4-5 years of age, mean+sd was calculated as 2.63+1.36 years, frequency of UTI in children on urine culture as a gold standard was recorded in 20.69%(n=84), the diagnostic accuracy of urine dipstick in detection of UTI in children keeping urine culture as a gold standard was recorded as 80.95%, 62.42%, 35.98%, 92.63% and 66.26% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate. Conclusion: We conclude that the diagnostic accuracy of urine dipstick in detection of UTI in children keeping urine culture as a gold standard is higher and this cost effective and easy technique may be used in our routine practice for prediction of UTI in children.


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