I. The diagnosis of urinary tract infection: comparison of urine culture from suprapubic aspiration and midstream collection in a children's out-patient department in Nigeria

Abstract

Suprapubic aspiration (SPA) was compared with midstream urine collection (MSU) in the diagnosis of urinary tract infection (UTI) in a busy paediatric out-patient department in Northern Nigeria, where usually only one specimen can be taken before starting antimicrobial therapy. SPA in 287 children was compared with 175 MSU collections. Urine was obtained at the first attempt in 260 (91%) SPA's which were easy to perform and safe. MSU collections were more difficult, particularly in the younger child. In 51 cases MSUs were compared with SPAs taken immediately before, and gave an accurate indication of urine infection with no false negative or positive cultures. It is concluded that when only one urine specimen can be collected before starting antimicrobial therapy, a single MSU specimen gives an adequate result if correctly collected and plated out. When accuracy of diagnosis is essential or if a MSU cannot be obtained, SPA is indicated. A white cell count on unspun urine proved to be the most successful sideroom test for urinary tract. Counts in excess of ten cells per mm3 were found in 62% of patients with positive cultures.

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

“…The latter was used in all further analyses, as this method was most frequently used in other studies. One further study reported results for both centrifuged and uncentrifuged Gram-stained urine; 87 again, the data for uncentrifuged Gramstained urine were used in further analyses. Four studies reported results using different cut-off points.…”

“…41,65,87,94,95 Four studies used culture alone of both urine samples, whereas one used a combination of culture and microscopy of the two samples. 41 Two studies each provided two estimates of test performance.…”

“…Twelve studies, with a total of 16 different test evaluations, compared the diagnostic accuracy of different methods of urine sampling 38,41,46,51,54,57,58,61,65,87,94,95 (Table 6). These studies compared the results of culture from urine obtained by different sampling methods.…”

How does study quality affect the results of a diagnostic meta-analysis?

“…In studies evaluating microscopy to detect pyuria three items showed a strong association with test performance in the weighted analysis (28 studies) [19-23,28,29,34,35,41,43,46,47,49,50,58,59,63,67,70,75,77,80,81,83,85,92-94]. The DOR was 1.3 (95% CI: 1.1, 1.6; p = 0.007) times higher in studies that adequately reported details of the reference standard execution.…”

“…Two items showed a strong evidence of an association with the DOR in the weighted analysis of studies evaluating microscopy to detect bacteriuria (22 studies) [20,21,23,28,34,35,41,47,50,61-64,67,70,76,77,80,85,90,91,94]. The DOR was 3.0 (95% CI: 1.6, 5.5, p = 001) times greater in studies in which incorporation bias was present compared to those in which it was avoided, and 5.3 (95% CI: 2.3, 12.0, p = 0.001) times greater if samples were Gram stained.…”