Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Abstract

BackgroundUrinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture.MethodsWe conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age.ResultsThe evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful.ConclusionDipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation.

Precisão da tira reagente e do exame microscópico da urina no diagnóstico de infecções do trato urinário em porcas

“…This result shows that the microscopic examination of the urine is reliable for diagnosing UTI, since even the five sows with false negative diagnosis for UTI through the nitrite test were detected with bacteriuria in the sediment test. Therefore, even though the microscopic examination of the urine to detect the presence of leukocytes and bacteria is more time consuming and harder to perform than the reagent strip test (Downs 1999), the former may be performed safely at the farm, whereas the bacteriological examination, regarded as the reference method for diagnosing UTI (Zorc et al 2005), needs to be performed in a laboratory, has a high cost and has the disadvantage of taking at least 48 hours for obtaining the results (Whiting et al 2005).…”

Performance Characteristics of Dipstick and Microscopic Urinalysis for Diagnosis of Urinary Tract Infection

“…Dipstick tests have the advantage of being quick and easy to perform and can be carried out in primary care giving an immediate result. Microscopic examination of urine samples for leukocytes, erythrocytes or bacteria is considerably more time consuming and labor intensive than the dipstick method (5). But false positive and false-negative rates are significantly higher as compared with the microscopic examination.…”

Bacterial isolates and their antimicrobial susceptibility patterns among pediatric patients with urinary tract infections

“…It causes significant morbidity and considerable mortality. [1] In these days, the significance of UTI has been increasingly important, particularly the role of UTI as an occult cause of febrile illness in young children. [2] Patients' symptoms are dysuria, urgent and frequent urination, flank pain, along with malodorous and/or cloudy urine.…”