The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients With Lower Urinary Tract Symptoms Without Acute Frequency and Dysuria

Khasriya, Rajvinder; Khan, Shozab; Lunawat, Rahul; Bishara, Samuel; Bignal, Jenine; Malone-Lee, Matthew; Ishii, Hiroumi; O'Connor, Dominic; Kelsey, M.C.; Malone‐Lee, James

doi:10.1016/j.juro.2010.01.008

Cited by 77 publications

(78 citation statements)

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“…The urinary dipstick test for nitrite and leukocyte esterase, calibrated to the Kass criterion, has been found to be unreliable (10)(11)(12). We studied dipsticks, microscopic pyuria, and MSU culture in patients with chronic painless lower urinary tract symptoms (LUTS) and discovered significant sensitivity deficiencies affecting all of these tests (7). Our culture data were very similar to the original findings reported by Stamm et al in 1982, showing that the Kass threshold is misleading (9).…”

Section: Cfu MLsupporting

confidence: 72%

“…Pyuria was very infrequent overall (22% [n ϭ 12] of LUTS patients versus 8% [n ϭ 2] of controls, which is not statistically different [ 2 ϭ 2.4, P ϭ 0.1]). This infrequency is not surprising, considering how weak this marker is for low-grade infections (7,32). Routine culture revealed that very few patients in either cohort tested positive by the Kass criterion (7% [n ϭ 4] of LUTS patients and 11% [n ϭ 3] of controls, which is not statistically different [ 2 ϭ 0.4, P ϭ 0.4]).…”

Section: Spectrum Of Lutsmentioning

confidence: 93%

“…Some of Kass' contemporaries criticized the use of a single threshold for diagnosing UTI in all diseases (5,6), and recently we and others also have come to question these assumptions (7)(8)(9). Biological systems fall along continuous spectra; therefore, a dichotomous judgment of no infection/significant infection using a fixed point, whether this be 10 5 , 10 4 , or 10 2 CFU ml Ϫ1 (9), may be inappropriate, especially for low-grade symptomatic infections.…”

Section: Cfu MLmentioning

confidence: 99%

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Spectrum of Bacterial Colonization Associated with Urothelial Cells from Patients with Chronic Lower Urinary Tract Symptoms

et al. 2013

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c Chronic lower urinary tract symptoms (LUTS), such as urgency and incontinence, are common, especially among the elderly, but their etiology is often obscure. Recent studies of acute urinary tract infections implicated invasion by Escherichia coli into the cytoplasm of urothelial cells, with persistence of long-term bacterial reservoirs, but the role of infection in chronic LUTS is unknown. We conducted a large prospective study with eligible patients with LUTS and controls over a 3-year period, comparing routine urine cultures of planktonic bacteria with cultures of shed urothelial cells concentrated in centrifuged urinary sediments. This comparison revealed large numbers of bacteria undetected by routine cultures. Next, we typed the bacterial species cultured from patient and control sediments under both aerobic and anaerobic conditions, and we found that the two groups had complex but significantly distinct profiles of bacteria associated with their shed bladder epithelial cells. Strikingly, E. coli, the organism most responsible for acute urinary tract infections, was not the only or even the main offending pathogen in this more-chronic condition. Antibiotic protection assays with shed patient cells and in vitro infection studies using patient-derived strains in cell culture suggested that LUTS-associated bacteria are within or extremely closely associated with shed epithelial cells, which explains how routine cultures might fail to detect them. These data have strong implications for the need to rethink our common diagnoses and treatments of chronic urinary tract symptoms.

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Section: Cfu MLsupporting

confidence: 72%

Section: Spectrum Of Lutsmentioning

confidence: 93%

Section: Cfu MLmentioning

confidence: 99%

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Spectrum of Bacterial Colonization Associated with Urothelial Cells from Patients with Chronic Lower Urinary Tract Symptoms

et al. 2013

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“…There is a limited evidence, yet general expert consensus that the beneits outweigh the costs [30]. The value of urinary dipstick/microscopy for diagnosing UTI in men with LUTS without acute frequency and dysuria has recently been questioned [31].…”

Section: Laboratory Testsmentioning

confidence: 99%

Assessment of Urinary Incontinence (UI) in Adult Patients

Rizvi¹,

Ather²

2017

Synopsis in the Management of Urinary Incontinence

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The diagnosis and assessment of urinary incontinence (UI) are variable. In general, diagnosis is made in primary care using clinical evaluation (a good history and physical examination), bladder diary and validated symptom scales. Condition-speciic diagnosis is made in secondary care, and it often involves interventional tools such as urodynamic studies. The evidence available on the accuracy and acceptability of the assessment of UI is inconsistent and variable. A structured data collection tool was used for initial assessment of UI. Some key questions are required for initial assessment of UI in order to diagnose the type of UI. This chapter includes a gender-speciic evaluation based on history and clinical examination. Pelvic organ prolapse (POP) in female patients is associated with UI and POP diagnosis, and staging is made by clinical examination only, while male patients are examined for prostate obstructive urinary symptoms. Basic evaluation includes bladder diary in cases of overactive bladder and stress test, for stress urinary incontinence. Other diagnostic tests include urine analysis, urolowmetry and measurement of postvoid residual volume in cases of neurogenic bladder and benign prostate hypertrophy. Patients referred to specialist require further assessment of UI using urodynamic testing, electrophysiological test and imaging.

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“…Aşırı antibiyotik kullanımının antibiyotik direncinde artışa sebep olması nedeniyle, sık karşılaşılan ve önemli bir sorun olan ÜSİ'ye doğru tanı konulması önem arz etmektedir (6). Hızlı ve doğru ÜSİ tanısı koyabilmek için laboratuvarlarda çeşitli yöntemlerin etkinliği araştırılmaktadır (7)(8)(9).…”

Section: Introductionunclassified

Comparison of Microbiological Methods for the Diagnosis of Urinary Tract Infections

Çalışkan¹,

Şahi̇n²,

Öztürk³

et al. 2014

Klimik Dergisi

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ÖzetAmaç: Üriner sistem infeksiyonları (ÜSİ), yetişkinlerde bakteriyel infeksiyonların en sık görülen sebebi olup, her iki cinste ve tüm yaş gruplarında görülebilmektedir. Bu çalışmada, ÜSİ'nin hızlı ve güvenilir tanısında, Gram boyaması, Thoma sayma kamarasında lökosit sayımı, nitrit testi ve lökosit esteraz (LE) testinin etkinliği, ÜSİ tanısında altın standard olan idrar kültürüyle karşılaştırılmıştır. Yöntemler: Mayıs-Kasım 2010 arasında polikliniklerden ya da yatan hastalardan gönderilen 658 idrar örneği incelenmiştir. Klinik bilgilerine ulaşılan, ÜSİ'yi düşündüren semptomları bulunan ve yaş aralığı 0-106 olan hastalar çalışmaya dahil edilmiştir. İdrar örnekleri, Gram boyaması, Thoma sayma kamarasında lökosit sayımı, nitrit testi ve LE testiyle incelenerek kültürleri yapılmıştır. Üreyen mikroorganizmalar klasik yöntemler ve API ® (bioMeriéux, Fransa) kullanılarak saptanmıştır. Bulgular: Örneklerin 137 (%20.8)'sinde üreme tespit edilmiş, 143 (%21.7)'ü kontaminasyon olarak değerlendirilmiştir. Gram boyamasının duyarlılığı %82.2, özgüllüğü %96.8, yalancı pozitifliği %3.2, yalancı negatifliği %17.8 olarak saptanmış olup, bu oranlar sırasıyla Thoma sayma kamarasında lökosit sayımı için, %78.8, %81.5, %18.5, %21.2; nitrit testi için, %40.1, %95.8, %4.2, %59.9; LE testi için, %88.1, %34.1, %65.9, %11.9 olarak tespit edilmiştir. Sonuçlar: Gram boyamasının, duyarlılık ve özgüllüğünün oldukça yüksek, yalancı pozitif ve yalancı negatifliklerinin diğer yön-temlere oranla düşük ve uygulanabilirliğinin kolay olması nedeniyle, ÜSİ'nin hızlı tanısında kullanılabilecek en uygun yöntem olduğu sonucuna varılmıştır. Klimik Dergisi 2013; 26(1): 9-12.Anahtar Sözcükler: Gram boyaması, lökosit esteraz, nitrit testi, Thoma sayma kamarasında lökosit sayımı, üriner sistem infeksiyonu. AbstractObjective: Urinary tract infections are the most frequent bacterial infections in adults and may be seen in all age groups and both genders. In this study, urine culture which is the gold standard diagnostic method of urinary tract infections is compared with Gram stain, Thoma counting chamber, nitrite reductase test and leukocyte esterase (LE) test in efficiency for rapid and reliable diagnosis of urinary tract infection. Methods: This study was performed in our laboratory between May 2010 and November 2010. 658 urine samples of patients with urinary tract infection symptoms from outpatient and inpatient clinics were included in the study. Urine samples were examined by Gram stain, leukocyte count in Thoma chamber, nitrit test and LE test, and cultured. Microorganisms were identified using conventional methods and API ® (bioMeriéux, Fransa) identification systems. Results: Cultures were found positive in 137 (20.8%) samples and 143 (21.7%) cultures were evaluated as contamination. For Gram stain, the results for sensitivity, specificity, false positivity and false negativity were 82.2%, 96.8%, 3.2%, and 17.8%, respectively. For Thoma counting chamber, the results were 78.8%, 81.5%, 18.5%, 21.2%, respectively. For nitrite reductase test they were...

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The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients With Lower Urinary Tract Symptoms Without Acute Frequency and Dysuria

Abstract: Despite official guidelines and widespread use these tests cannot be considered appropriate for diagnosing urinary tract infection in patients with lower urinary tract symptoms, and should be abandoned in this context.

Cited by 77 publications

References 16 publications

Spectrum of Bacterial Colonization Associated with Urothelial Cells from Patients with Chronic Lower Urinary Tract Symptoms

Spectrum of Bacterial Colonization Associated with Urothelial Cells from Patients with Chronic Lower Urinary Tract Symptoms

Assessment of Urinary Incontinence (UI) in Adult Patients

Comparison of Microbiological Methods for the Diagnosis of Urinary Tract Infections

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