Use of Urinary Gram Stain for Detection of Urinary Tract Infection in Infants

Lockhart, Gregory R.; Lewander, William J.; Cimini, Donna M; Josephson, Stephen L.; Linakis, James G.

doi:10.1016/s0196-0644(95)70351-9

Cited by 54 publications

(35 citation statements)

References 12 publications

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“…A study by Lockhart and colleagues 12 of 207 infants Ͻ6 months of age with fever found the Gram stain to have a sensitivity of 94% (95% CI: 73,100) and specificity of 92% (95% CI: 8,95), which are comparable with our findings. Because its cost and difficulty of performance are much greater than the for the dipstick test, it is not as attractive as the dipstick test in clinical practice.…”

Section: Discussionsupporting

confidence: 90%

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Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

et al. 1998

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ABSTRACT. Objective. Comparison of rapid tests and screening strategies for detecting urinary tract infection (UTI) in infants.Methods. Cross-sectional study conducted in an urban tertiary care children's hospital emergency department and clinical laboratories of 3873 infants <2 years of age who had a urine culture obtained in the emergency department by urethral catheterization; results of urine dipstick tests for leukocyte esterase or nitrites, enhanced urinalysis (UA) (urine white blood cell count/mm 3 plus Gram stain), Gram stain alone, and dipstick plus microscopic UA (white blood cells and bacteria per high-powered field) compared with urine culture results (positive urine results defined as >10 4 colony-forming units per milliliter of urinary tract pathogen) for each sample. Cost comparison of 1) dipstick plus culture of all urine specimens versus 2) cell count ؎ Gram stain of urine, culture only those with positive results.Results. The enhanced UA was most sensitive at detecting UTI (94%; 95% confidence interval: 83,99), but had more false-positive results (16%) than the urine dipstick or Gram stain (3%). The most cost-effective strategy was to perform cultures on all infants and begin presumptive treatment on those whose dipstick had at least moderate (؉2) leukocyte esterase or positive nitrite at a cost of $3.70 per child. With this strategy, all infants with UTI were detected. If the enhanced UA was used to screen for when to send the urine for culture, 82% of cultures would be eliminated, but 4% to 6% of infants with UTI would be missed and the cost would be higher ($6.66 per child).Conclusion. No rapid test can detect all infants with UTI. Physicians should send urine for culture from all infants and begin presumptive treatment only on those with a significantly positive dipstick result. The enhanced UA is most sensitive for detecting UTI, but is less specific and more costly, and should be reserved for the neonate for whom a UTI should not be missed at first visit. Pediatrics 1998;101(6). URL: http://www.pediatrics. org/cgi/content/full/101/6/e1; urinalysis, Gram stain, dipstick, UTI, rapid screening, febrile infants.ABBREVIATIONS. UTI, urinary tract infection; ED, emergency department; WBC, white blood cells; UA, urinalysis; LE, leukocyte esterase; CFU/mL, colony forming units per milliliter; CI, confidence interval. R ecent research has indicated that the prevalence of urinary tract infection (UTI) in febrile young children in the emergency department (ED) is ϳ3% to 5%, and in some groups, as high as 30%.1,2 Additionally, recent use of nuclear renal scans has indicated that the majority of febrile young children with UTI have pyelonephritis, putting them at risk for renal scarring and the possible long-term sequelae of hypertension and chronic renal failure. [3][4][5] It is imperative that physicians identify these children to institute early treatment, work-up of their urinary tracts, and provide follow-up.Although there are several screening tests for UTI, there has been no prospective clinical...

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Section: Discussionsupporting

confidence: 90%

“…Previous studies 9,10,12 of young children have found it to have sensitivity in the 57% to 87% range, with lower specificity of 53% to 79%. It may perform better in older, symptomatic chil- dren.…”

Section: Discussionmentioning

confidence: 82%

Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

et al. 1998

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“…1,3,4 Above cited techniques are time consuming and expensive. There are several studies in which urinary gram stain was utilized for UTI detection.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 However, since decades urine culture has been the gold standard for detection of UTI. 1,3,4 Above cited techniques are time consuming and expensive. There are several studies in which urinary gram stain was utilized for UTI detection.…”

Section: Introductionmentioning

confidence: 99%

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Utility of urinary gram stain as a diagnostic method for urinary tract infection

2018

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INTRODUCTIONUrinary tract infection (UTI) is a common health problem. Most of the times, clinical findings of UTI are subtle and non-specific and present with fever only. However, UTI can pose serious complications like septicemia, renal abscesses etc.Hence, timely and accurate diagnosis of UTI is pertinent. Microscopic urinary sediment analysis, urine culture, dipstick analysis are the common methodologies used to detect UTI. Recently, even flow cytometry, renal or bladder ultrasound, cystourethrogram were also utilized for diagnosis of UTI.1,2 However, since decades urine culture has been the gold standard for detection of UTI. 1,3,4 Above cited techniques are time consuming and expensive. There are several studies in which urinary gram stain was utilized for UTI detection. [3][4][5][6] In the present study, we evaluated the efficiency of urinary gram stain for detection of UTI using urine culture as gold standard. METHODSThe midstream urine specimen was collected in sterilized tubes from male (55 cases) and female patients (45 cases) in the age group of 20-50years with clinical symptoms suggesting UTI. All the urine samples were processed by centrifugation at 3000rpm for 15minutes. Centrifuged samples were submitted for urine microscopy, urinary gram stain and urine culture. The patients receiving ABSTRACTBackground: Urinary tract infection (UTI) is one of the most common infections in humans. Timely diagnosis and treatment are necessary to reduce the complications from UTI. Urine culture is still the gold standard diagnostic test for UTI, however it is costly and time consuming. The present study was conducted to compare the utility of urinary gram stain, microscopy of centrifuged urine sample and urine culture for the diagnosis of UTI. Methods: 100 urine samples were processed for gram stain, culture and microscopy. Urinary gram stain findings were correlated with microscopy and culture results. Using urine culture as gold standard, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of urinary gram stain were assessed for the diagnosis of UTI. Results: The accuracy of urinary gram stain for detection of UTI was 97%. Conclusions: Urinary gram stain is a reliable diagnostic test for early detection of UTI.

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Reliability of the Urinalysis for Predicting Urinary Tract Infections in Young Febrile Children

Bachur¹,

Harper²

2001

Arch Pediatr Adolesc Med

122

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Use of Urinary Gram Stain for Detection of Urinary Tract Infection in Infants

Cited by 54 publications

References 12 publications

Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

Utility of urinary gram stain as a diagnostic method for urinary tract infection

Reliability of the Urinalysis for Predicting Urinary Tract Infections in Young Febrile Children

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