Cost-effective screening for urinary tract infections in urogynaecological patients

Abstract

This study aims to test the cost-effectiveness of reagent-strip urine nitrite compared with microbiological laboratory testing for screening of urinary tract infections (UTI). The study is a retrospective review of 708 female patients who underwent cystometry during a 1-year period. Urine dipstick nitrite was used as a screening test for UTI while urine cultures were taken as an outcome. Symptoms of UTI were noted. Of 708 patients screened, 70 (9.9%) had a significant UTI. Only 32 (4.5%)of 708 patients were nitrite positive. Urine dipstick nitrite has sensitivity of 40%, specificity of 99%, positive predictive value (PPV) of 88 % and negative predictive value (NPV) of 94%. If the screening test included symptoms for UTI together with urine nitrite, the results are: sensitivity 89%, specificity 31%, PPV 12% and NPV 96%. A combination of screening with urine nitrite and UTI symptoms can increase sensitivity to 89%. A total of 29% of specimens (screen negative=nitrite negative/asymptomatic) can then be excluded from UFEME/culture testing, thus resulting in cost savings.

Overactive bladder in women: Does low‐count bacteriuria matter? A review

“…1), recommending thresholds for women of >10 3 CFU/ml in acute uncomplicated cystitis or, in the case of complicated UTI, >10 5 CFU/ml in a voided specimen (>10 4 CFU/ml in a catheter specimen). 24 Despite this, many recent studies, in both gynaecological 25,26 and non-gynaecological 27 populations continue to use >10 5 CFU/ml as their threshold, even among symptomatic women. Indeed, the recent joint ICS/IUGA consensus document on the terminology of pelvic floor dysfunction, endorses a threshold of >10 5 CFU/ml for voided specimens in the diagnosis of UTI.…”

“…1). 21,26 Women with frequency/urgency/nocturia without dysuria represent a different patient cohort to acutely dysuric women. The diagnostic need for pyuria in these women is poorly studied.…”

Aberration of French Public Health Authorities policies for the cost-assessment of microbiological diagnosis in ophthalmology

“…Both signals are interpreted in combination, allowing for ruling-in (both positive) and -out (both negative) urinary tract infections (Whiting et al, 2006). It was shown that dipstick negative for both LE and nitrite of a clean voided urine-bag, or nappy/pad specimen can be used to rule out UTI, excluding these samples from further investigation and establishing in less than 2 min negative conclusions (Wong et al, 2008;Ducharme, 2007). A dipstick positive for either LE or nitrite provides inconclusive diagnosis and further cultures are required (negativity to the LE or the nitrite assay or both has a specificity of 92.8%).…”