Comparison of urine Gram stain and urine culture to diagnose urinary tract infection in children

Abstract

Background Urinary tract infection (UTI) are due to pathogeninvasion of the urinary tract. The upper or lower tract may beaffected, depending on the presence of infection in the kidney,or bladder and urethra. Infection of urinary tract affect up to10% of children and are the most common bacterial infection ininfants and young children worldwide. The prevalence of UTI is3-5% in girls and 1 % in boys. Urine culture is considered to bethe gold standard diagnostic test for UTI. However, Gram stainsof uncentrifuged urine have been done in rural health centers andlaboratories in peripheral areas that lack facilities to evaluate urinespecimens. Gram stains of urine may be an effective method forruling out UTI in rural health center patients, thus saving timeand money in impoverished settings.Objective To compare urine Gram stain and urine culture asdiagnostic tests for UTI in children.Methods This cross-sectional study was held in H. Adam MalikHospital from May to June 2010. The 54 participants were aged0 - 14 years, suspected to have UTI and recruited by consecutivesampling. Urine was collected after the external urethral orificewas cleaned. A drop of the urine specimen was Gram stainedand examined by a light microscope, while the remainder of thespecimen was used for laboratory urine cultures. If Gram negativebacteria were observed by Gram stain, we considered the subjectto have UTI.Results The sensitivity and specificity of urine Gram staincompared to urine culture were 88% and 100%, respectively. Thepositive predictive value (PPV) and negative predictive value(NPV) were 100% and 90%, respectively.Conclusion Urine Gram stain may be a good alternative to urineculture for diagnosing UTI in children living in areas with limitedhealth care facilities.

A retrospective study of predictive value of Gram staining in the diagnosis of urinary tract infection

“…For clean-catch, un spun urine, the presence of at least one bacteria is likely to indicate a bacterial count of ≥10 5 CFU/ml, and the absence of bacteria in several fields on a Gram stain indicates the probability of fewer than 10 4 bacteria/ml. 15,17 Gram stain is a quick and reliable substitute to culture report and in selection of antibiotics for empirical therapy. However, the treating clinicians must look into the local sensitivity pattern of the probable causative agents and in institutions one must follow the recommendation laid by the board of antimicrobial policy.…”

Pewarnaan Gram Urin untuk Diagnosis Infeksi Saluran Kemih pada Anak Usia 2 Bulan hingga 2 Tahun

“…Sensitivitas pada studi ini lebih rendah dibandingkan dengan studi lain yang memiliki sensitivitas 88%. 22 Sensitivitas yang lebih tinggi juga didapatkan pada sebuah meta-analisis yakni 91% 16 dan meta-analisis lain sebesar 93%. 15 Sensitivitas yang lebih rendah pada studi ini dapat disebabkan oleh beberapa faktor seperti panas yang berlebihan selama fiksasi, rendahnya konsentrasi kristal violet, pencucian berlebihan, paparan iodin yang kurang memadai, dekolorisasi jangka panjang dan counterstaining yang berlebihan selama pewarnaan Gram.…”

“…23 Spesifisitas pewarnaan Gram pada penelitian ini serupa dengan studi lain yakni 97% dan 100%. 10,22 Spesifisitas pewarnaan Gram yang tinggi dalam mendiagnosis ISK menujukkan rendahnya hasil positif palsu. Berdasarkan hasil penelitian ini, antibiotik harus segera diberikan setelah hasil pewarnaan Gram menunjukkan hasil positif.…”