Diagnostic accuracy of nitrite dipstick testing for the detection of bacteriuria of pregnancy

Kodikara, Hemal; Seneviratne, Harshalal R.; Kaluarachchi, Athula; Corea, Enoka

doi:10.1016/j.puhe.2009.01.007

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…A strength of this study is that our data were collected during everyday practice, enhancing the generalizability of our results. Additionally, compared to most other studies, the analysis was performed in a relatively large cohort of pregnant women; other studies included 100–200 pregnant women [ 18 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Physiological changes during pregnancy can mimic UTI symptoms, such as frequent voiding due to the fetal pressure on the maternal bladder [ 16 , 17 ]. Previous research reported that 12% of pregnant women reported dysuria and 20% frequent voiding without the presence of bacteriuria [ 18 ]. Symptoms can also be non-specific, such as, for example, uterine contractions which can be a symptom of a UTI but also occur in physiologic pregnancies [ 16 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Urine Dipsticks for Urinary Tract Infection Diagnosis during Pregnancy: A Retrospective Cohort Study

Werter,

Schneeberger,

Geerlings

et al. 2024

Antibiotics

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Objective: Urinary tract infections (UTIs) represent the most prevalent infections among pregnant women. Many pregnant women experience frequent voiding or lower abdominal pain during pregnancy due to physiologic changes. Due to the possible consequences of a UTI in pregnancy, pregnant women are more often tested for UTIs. This study aimed to assess the diagnostic accuracy of dipsticks in diagnosing UTIs in pregnant women while using the urine culture as the reference standard. Study design: This was a retrospective cohort study, conducted at two academic hospitals in the Netherlands among pregnant women. Pseudonymized data were collected from patient files. The results of the urine dipstick and the urine culture in pregnant women were linked. Additionally, nitrofurantoin prescriptions were linked to culture results. A positive urine culture was considered the reference test for a UTI. Results: Between 1 January 2017 and 28 February 2021, a total of 718 urine samples with leukocyte esterase dipstick results within 24 h of the urine culture were analyzed. Of these samples, a nitrite dipstick result was also available in 337 cases. Only 6.8% of the 718 urine samples yielded positive cultures. The sensitivity and specificity of leukocyte esterase were 75.5% and 40.4%, respectively; for nitrite, 72.0% sensitivity and 73.4% specificity were found. When at least one of the two tests was positive, the sensitivity and specificity were 92.0% and 27.9%, respectively. When both tests were positive, the sensitivity and specificity were 52.0% and 82.7%, respectively. In only 16.8% of the women to whom nitrofurantoin was prescribed, the urine cultures returned positive using a cut-off of 105 colony forming units/mL. Conclusion: The diagnostic performance of leukocyte esterase, nitrite, or their combination in clinical practice is lower than previously reported in study settings among pregnant women. A significant proportion of women treated with nitrofurantoin were found to have no UTI, suggesting potential over-prescription based on dipstick test results. Healthcare providers should be aware of this reduced performance in clinical practice and carefully weigh the risks of antibiotic treatment by suspicion of a UTI against the possibility of delayed treatment awaiting culture results in individual patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Urine Dipsticks for Urinary Tract Infection Diagnosis during Pregnancy: A Retrospective Cohort Study

Werter,

Schneeberger,

Geerlings

et al. 2024

Antibiotics

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“…15 This result is also supported by Kodikara et al who reported that of women diagnosed with UTI, 60% belonged to the age group of 20 to 30 years. 18 This result is consistent with a study by Millar et al who reported that a higher percentage of UTI among women was found within the age group of 20 to 29 years. 19…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Structured Counseling and Preventive Strategies in Promoting Awareness and Expressed Habitual Practices Toward Prevention of Urinary Tract Infection Among Women of Reproductive Age Group: A Pilot Study

Sequera

Chacko

2022

Journal of Health and Allied Sciences NU

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Objectives Urinary tract infection (UTI) is the most common infection that affects half of all women in their lifetime and one-fourth have recurrent infections. Health behaviors could prevent the recurrence of UTIs and therefore motivation and increasing awareness are necessary for healthy behavior change. This study was done to evaluate the effectiveness of structured counseling and preventive strategies (SCAPS) in promoting awareness and expressed habitual practices among the women of the reproductive age group to prevent UTI. Materials and Methods Block randomization with multiple interventions and follow-up were conducted among 60 women (30 in each group, randomly assigned using the SNOSE technique) attending the OBG and urology OPDs of a selected medical college hospital. Purposive sampling was used to select the subjects. Women who were positive for urine culture and experiencing typical symptoms of UTI, as assessed using the symptom score checklist, were recruited for the study. Pre-test awareness was assessed using a structured awareness questionnaire and a rating scale for expressed habitual practice. After the pre-test, on the same day, the experimental group received SCAPS intervention followed by a second session during the third month. At the third (before the second session) and the sixth-month post-tests were conducted by delivering the same tool to determine the post-test level of awareness and expressed habitual practice after the administration of SCAPS. Results The study shows there is a significant difference in the awareness and expressed habitual practice values in the experimental group (p < 0.005). The effectiveness of SCAPS showed that the mean ± standard deviation (SD) pre-test score of women (awareness - x̄1 ± SD = 9.47 ± 2.57, hygienic habitual practice - x̄1 ± SD = 20.93 ± 1.91, fluid and dietary practice - x̄1 ± SD = 7.73 ± 2.18 and sexual habits - x̄1 ± SD= 8.00 ± 3.33) was significantly lower than the mean ± SD post-test scores (awareness - x̄2 ± SD =11.37 ± 1.65, awareness - x̄3 ± SD = 12.00 ± 1.05), (hygienic habitual practice - x̄2 ± SD = 22.57 ± 2.16, x̄3 ± SD = 23.90 ± 1.99), (fluid and dietary practice - x̄2 ± SD = 10.07 ± 2.21, x̄3 ± SD =11.97 ± 1.79) and (sexual habits - x̄2 ± SD = 8.81 ± 2.51, x̄3 ± SD =9.81 ± 2.26). Conclusion SCAPS was found to be effective on awareness and preventive habitual practices with regard to UTI. SCAPS can be recommended for vulnerable groups such as females so that UTI could be prevented. Trial Registration CTRI/2018/10/016064 (Registration on 17/10/2018).

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“…In our study the nitrite dipstick had a sensitivity of 82.5% and a specificity of 99.9%, making it a good screening test for asymptomatic bacteriuria. Previous studies have reported the sensitivity of the nitrite test to be 67.5%, [2] 60% [14] and 75%, [15] while the specificity was 99.7%, 99.2% and 99%, respectively. Combined dipstick tests (LE + nitrite) when used in parallel (either test positive) in our study increased the sensitivity to 87.3%, with a specificity of 96.2%.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic bacteriuria in women attending an antenatal clinic at a tertiary care centre

Titoria¹,

Gupta²,

Rathore³

et al. 2014

S Afr J OG

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Objective.To compare the diagnostic performance of urine microscopy, leucocyte esterase and nitrite dipstick tests and various combinations of these as screening tests for asymptomatic bacteriuria in pregnancy. Methods. Pregnant women (N=800) attending an antenatal clinic were recruited at their first visit. Urine microscopy, culture and dipstick testing were performed on a random clean-catch midstream urine sample. A count of >10 5 colony-forming units of a single organism per millilitre of urine was taken as significant. Dipstick results were read as positive according to the manufacturer's instructions. Results. A total of 800 eligible women were screened. The prevalence of asymptomatic bacteriuria as diagnosed by urine culture was 5.0% (n=40). Escherichia coli was the most prevalent uropathogen isolated by culture (60.0%). Neither urine microscopy nor the leucocyte test was found to be sufficiently sensitive to be used as a single screening test for asymptomatic bacteriuria in pregnant patients. The nitrite test alone had a sensitivity of 82.5% and a specificity of 99.9%. Combined dipstick testing had an improved sensitivity of 87.3% and a specificity of 96.2%. Addition of urine microscopy to combined dipstick testing increased the sensitivity to 95.0%, and the specificity became 92.4%. Conclusion. Combined dipstick testing is a useful screening test for asymptomatic bacteriuria in pregnancy. Addition of urine microscopy to combined dipstick testing further improves its diagnostic performance.

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Diagnostic accuracy of nitrite dipstick testing for the detection of bacteriuria of pregnancy

Cited by 8 publications

References 9 publications

Diagnostic Accuracy of Urine Dipsticks for Urinary Tract Infection Diagnosis during Pregnancy: A Retrospective Cohort Study

Diagnostic Accuracy of Urine Dipsticks for Urinary Tract Infection Diagnosis during Pregnancy: A Retrospective Cohort Study

Effectiveness of Structured Counseling and Preventive Strategies in Promoting Awareness and Expressed Habitual Practices Toward Prevention of Urinary Tract Infection Among Women of Reproductive Age Group: A Pilot Study

Asymptomatic bacteriuria in women attending an antenatal clinic at a tertiary care centre

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