How sensitive are dipstick urinalysis and microscopy in making diagnosis of urinary tract infection in children?

Abstract

Background: Urinary tract infection (UTI) is a common reason for referral to the emergency department (ED) especially in unwell infants. Upper UTIs are particularly at risk of significant complications later in life. Rapid dipstick urinalysis and microscopy are often used in unwell children as a screening tool to guide early diagnosis and treatment. This study aims to evaluate the sensitivity of dipstick urinalysis and microscopy in the diagnosis of UTI. Methods: A retrospective review of children aged 16 years and below with positive urine culture (UC) over a 3-year period was done. The results of urine dipstick and microscopy were compared with the positive UC and sensitivities calculated. Results: Dipstick urinalysis and microscopy of 262 children were studied. Female-to -male ratio of 1.8:1. Median age was 0.79 (range: 0.02–15.95) years. The sensitivity of nitrite, blood, and leukocyte esterase (LE) were 0.54, 0.74, and 0.86 (95% confidence interval [CI] = 0.46–0.62, 0.68–0.80, and 0.82–0.91), respectively. The sensitivity of pyuria of ≥100 cells/mm 3 was 0.92 (95% CI = 0.89–0.95). The presence of any of the 3 dipstick parameters increased the sensitivity to 0.97 (95% CI = 0.95–0.99). The lowest sensitivity 0.49 (95% CI = 0.40–0.58) was found with combined positive LE and nitrite. There was a significant comparison between positive LE dipstick test and pyuria ( P = 0.000004). Conclusions: Dipstick urinalysis may not be reliable in ruling out UTI in children. However, considering both positive dipstick and pyuria will be more useful in making the diagnosis.

The Effectiveness of Dipstick for the Detection of Urinary Tract Infection

“…However, quantitative urine culture is laborious and requires a longer period to complete. Consequently, in most primary care settings, the use of a single (most often dipstick) or rarely two of these protocols without quantitative urine culture is often relied upon for clinical laboratory diagnosis of UTI [6, 7]. Urine culture is most often requested only when a patient is having a recurrent infection or when symptoms are quite severe.…”

Frequency of culture positive urinary tract infection in febrile children.

“…16 Recognizig UTI in initial stages is importent as missed diagnosis can lead to disastrous effect including renal scarring, Chronic kidney damage and hypertension.For treating Urinary tract infection properly it is of utmost importance that organism should be cultured and local sensitivity pattern should be obtained. 17 Urinary tract infections are not widely recognized as a cause of childhood disease. Urine culture has the problem of taking 48 hours to get a result.…”

“…The microscopic examination of urine for leukocytes or bacteria is also critical in the diagnosis of Urinary1tract infection. 17 Clinicians only order urine culture findings if they are concerned about urinary tract infection. Although methods for identifying children with a high risk of UTI have been developed, they are not routinely used by doctors.…”

Utilizing Dipsticks to Measure Leukocyte Esterase in Urine to Detect UTIS

“…Quantitative urine culture, on the other hand, takes more time and effort to finish. For this reason, the use of one (typically dipstick) or very infrequently two of these protocols without quantitative urine culture is frequently relied upon for clinical laboratory diagnosis of UTI in most primary care settings [7,8]. Most of the time, a urine culture is only ordered when a patient has quite severe symptoms or a recurring infection.…”