Diagnostic value of different urine tests for urinary tract infection: a systematic review and meta-analysis

Xie, Rong; Li, Xinli; Li, Guangquan; Fu, Rong

doi:10.21037/tau-22-65

Cited by 12 publications

(9 citation statements)

References 33 publications

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“…In our opinion, this is unlikely: many symptoms are not specific to UTI, and there appears to be a ceiling on diagnostic performance using this approach. Of future interest would be to assess the gain in performance in using point-of-care tests for diagnostic purposes, which is the subject of one systematic review 29 and an ongoing subsequent review. 30 …”

Section: Discussionmentioning

confidence: 99%

Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study

Fanshawe¹,

Judge²,

Mort³

et al. 2023

Journal of Antimicrobial Chemotherapy

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Objectives Given the lack of accurate rapid diagnostics for urinary tract infection (UTI) in women, many countries have developed guidelines aiming to support appropriate antibiotic prescribing, but some guidelines have not been validated. We performed a diagnostic accuracy validation study of two guidelines: Public Health England (GW-1263) and Scottish Intercollegiate Guidelines Network (SIGN160). Methods We used data from women with symptoms suggestive of uncomplicated UTI from a randomized controlled trial comparing urine collection devices. Symptom information was recorded via baseline questionnaire and primary care assessment. Women provided urine samples for dipstick testing and culture. We calculated the number within each risk category of diagnostic flowcharts who had positive/mixed growth/no significant growth urine culture. Results were presented as positive/negative predictive values, with 95% CIs. Results Of women aged under 65 years, 311/509 (61.1%, 95% CI 56.7%–65.3%) classified to the highest risk category (recommended to consider immediate antibiotic prescribing) and 80/199 (40.2%, 95% CI 33.4%–47.4%) classified to the lowest risk category (recommended to reassure that UTI is less likely) by the GW-1263 guideline (n = 810) had positive culture. For the SIGN160 guideline (n = 814), the proportion with positive culture ranged from 60/82 (73.2%, 95% CI 62.1%–82.1%) in those for whom immediate treatment was indicated to 33/76 (43.4%, 95% CI 32.3%–55.3%) in those recommended a self-care/waiting strategy. Conclusions Clinicians should be aware of the potential for diagnostic error when using diagnostic guidelines for managing uncomplicated UTI and making antimicrobial prescribing decisions. Infection cannot be excluded on the basis of symptoms and dipstick testing alone.

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Section: Discussionmentioning

confidence: 99%

Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study

Fanshawe¹,

Judge²,

Mort³

et al. 2023

Journal of Antimicrobial Chemotherapy

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“…The study was performed on 180 urine samples from anonymous patients, kindly provided by a regional general hospital, from 9 June to 15 September 2022. All the samples were first analyzed in the hospital microbiological laboratory by flow cytometry technique using the commercial urine particle analyzer UF-1000i instrument [ 3 ], reporting the concentrations of bacteria (BACT), white blood cells (WBL), fungi (F), epithelial and squamous cells (ESC) [ 27 , 28 , 29 , 30 , 31 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, the CPT has the disadvantages that it usually requires more than 24 h and it is costly. Faster and more cost-effective approaches, based on dipstick analysis, are not satisfactory in terms of specificity and sensitivity [ 2 , 3 ]. Urine flow cytometry (UFC) is an attractive alternative for diagnosis of UTIs, leading to a reduction in cultures and antibiotics [ 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Label-Free Analysis of Urine Samples with In-Flow Digital Holographic Microscopy

Gigli,

Braidotti,

Lima

et al. 2023

Biosensors

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Urinary tract infections are among the most frequent infectious diseases and require screening a great amount of urine samples from patients. However, a high percentage of samples result as negative after urine culture plate tests (CPTs), demanding a simple and fast preliminary technique to screen out the negative samples. We propose a digital holographic microscopy (DHM) method to inspect fresh urine samples flowing in a glass capillary for 3 min, recording holograms at 2 frames per second. After digital reconstruction, bacteria, white and red blood cells, epithelial cells and crystals were identified and counted, and the samples were classified as negative or positive according to clinical cutoff values. Taking the CPT as reference, we processed 180 urine samples and compared the results with those of urine flow cytometry (UFC). Using standard evaluation metrics for our screening test, we found a similar performance for DHM and UFC, indicating DHM as a suitable and fast screening technique retaining several advantages. As a benefit of DHM, the technique is label-free and does not require sample preparation. Moreover, the phase and amplitude images of the cells and other particles present in urine are digitally recorded and can serve for further investigation afterwards.

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“…The rate of false-negative and sterile cultures in UTIs is a critical consideration for accurate diagnosis and treatment. Urine cultures, while standard for UTI diagnosis, are known to have a high frequency of both false-positive and false-negative results [ 13 ]. The diagnostic threshold itself is often debated, with true UTIs sometimes associated with uropathogen growth of less than 100,000 CFU/mL, challenging the conventional threshold of ≥100,000 CFU/mL traditionally used to indicate an infection [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Microbial Species and Multidrug Resistance Patterns Associated with Lower Urinary Tract Infections in Preterm and Full-Term Births

Bratosin,

Folescu,

Krupyshev

et al. 2024

Microorganisms

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The rise of multidrug-resistant organisms has significantly complicated the clinical management of urinary tract infections (UTIs), particularly in the context of pregnancy. This study aimed to identify and analyze the significant differences in microbial species and multidrug resistance patterns associated with UTIs in preterm versus full-term births, determine the bacterial species significantly associated with preterm birth, and describe the antibiotic resistance patterns affecting pregnant women with UTIs. This case–control study was conducted in western Romania and focused on pregnant women with UTIs admitted from 2019 to 2023. Data were retrospectively collected from 308 patients with positive cultures. Statistical analyses, including the Chi-square test, Fisher’s exact test, and logistic regression models, were employed to compare the proportions of microbial species and resistance patterns between preterm (n = 126) and full-term (n = 182) birth groups and identify factors independently associated with preterm birth. The study found no significant differences in demographic or lifestyle factors between the groups. However, significant differences were observed in several infection and inflammation markers. The median white blood cell count was higher in the preterm group (12.3 vs. 9.1, p = 0.032), and the median C-reactive protein level was significantly higher in the preterm group (18 vs. 7, p < 0.001). The preterm group exhibited a higher incidence of multidrug-resistant organisms, notably ESBL-producing organisms (19.8% vs. 4.4%, p < 0.001) and carbapenem-resistant Enterobacteriaceae (4.8% with p = 0.003). Notably, the resistance to amoxicillin was significantly higher in the preterm group (20.6% vs. 6.6%, p < 0.001). Significant bacterial associations with preterm births included Group B Streptococcus (OR 2.5, p = 0.001) and Enterobacter spp. (OR 1.8, p = 0.022). The study confirmed significant differences in microbial species and multidrug resistance patterns between UTIs associated with preterm and full-term births. The higher prevalence of certain bacteria and increased resistance to commonly used antibiotics in the preterm group underscore the need for tailored antimicrobial therapies and robust microbial identification in managing UTIs during pregnancy.

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Diagnostic value of different urine tests for urinary tract infection: a systematic review and meta-analysis

Cited by 12 publications

References 33 publications

Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study

Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study

Label-Free Analysis of Urine Samples with In-Flow Digital Holographic Microscopy

Comparative Analysis of Microbial Species and Multidrug Resistance Patterns Associated with Lower Urinary Tract Infections in Preterm and Full-Term Births

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