Accurate and fast diagnostic algorithm for febrile urinary tract infections in humans

E. Gieteling, J. J.C.M. van de Leur, C. A. Stegeman, P. H.P. Groeneveld

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The urine dipstick that detects nitrite and leukocyte esterase, and urine sediment is commonly used to diagnose or exclude urinary tract infections (UTIs) as the source of infection in febrile patients admitted to the emergency department of Dutch hospitals. However, the diagnostic accuracy of the urine dipstick and urine sediment has never been studied in this specific situation.Methods: Urinary samples of 104 febrile consecutive patients were examined. Urine culture with ≥ 105 colonies/ ml of one or two known uropathogen was used as the gold standard. The diagnostic value of the urine dipstick, urine sediment and Gram stain at various cut-off points was determined and used to develop a new diagnostic algorithm. This algorithm was validated in a new group of sepsis patients based on systemic inflammatory response syndrome (SIRS) criteria. Results: A positive nitrite on the urine dipstick (specificity 99%) rules in UTI. This is the first step of our diagnostic algorithm. The second step is to exclude UTI by absence of bacteria in the urine sediment (sensitivity 94%). The thirdand last step is the number of leucocytes/high-power field (hpf) in the urine sediment. Less than 10 leucocytes/hpfmakes UTI unlikely whereas ≥ 10 leucocytes/hpf indicates UTI. In contrast to urine dipstick and/or urine sediment results alone, our algorithm showed both a high sensitivity (92%) and specificity (92%) and was validated in a new sepsis population. Conclusion: Our accurate and fast diagnostic algorithm, which combines the selective results of urine dipstick and urine sediment, can be easily used to diagnose UTI in febrile patients at the emergency department of Dutch hospitals.

Original languageEnglish
Pages (from-to)356-362
Number of pages7
JournalNetherlands Journal of Medicine
Volume72
Issue number7
Publication statusPublished - 1 Jan 2014

Cite this

Gieteling, E., van de Leur, J. J. C. M., Stegeman, C. A., & Groeneveld, P. H. P. (2014). Accurate and fast diagnostic algorithm for febrile urinary tract infections in humans. Netherlands Journal of Medicine, 72(7), 356-362.
Gieteling, E. ; van de Leur, J. J.C.M. ; Stegeman, C. A. ; Groeneveld, P. H.P. / Accurate and fast diagnostic algorithm for febrile urinary tract infections in humans. In: Netherlands Journal of Medicine. 2014 ; Vol. 72, No. 7. pp. 356-362.
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abstract = "Background: The urine dipstick that detects nitrite and leukocyte esterase, and urine sediment is commonly used to diagnose or exclude urinary tract infections (UTIs) as the source of infection in febrile patients admitted to the emergency department of Dutch hospitals. However, the diagnostic accuracy of the urine dipstick and urine sediment has never been studied in this specific situation.Methods: Urinary samples of 104 febrile consecutive patients were examined. Urine culture with ≥ 105 colonies/ ml of one or two known uropathogen was used as the gold standard. The diagnostic value of the urine dipstick, urine sediment and Gram stain at various cut-off points was determined and used to develop a new diagnostic algorithm. This algorithm was validated in a new group of sepsis patients based on systemic inflammatory response syndrome (SIRS) criteria. Results: A positive nitrite on the urine dipstick (specificity 99{\%}) rules in UTI. This is the first step of our diagnostic algorithm. The second step is to exclude UTI by absence of bacteria in the urine sediment (sensitivity 94{\%}). The thirdand last step is the number of leucocytes/high-power field (hpf) in the urine sediment. Less than 10 leucocytes/hpfmakes UTI unlikely whereas ≥ 10 leucocytes/hpf indicates UTI. In contrast to urine dipstick and/or urine sediment results alone, our algorithm showed both a high sensitivity (92{\%}) and specificity (92{\%}) and was validated in a new sepsis population. Conclusion: Our accurate and fast diagnostic algorithm, which combines the selective results of urine dipstick and urine sediment, can be easily used to diagnose UTI in febrile patients at the emergency department of Dutch hospitals.",
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Gieteling, E, van de Leur, JJCM, Stegeman, CA & Groeneveld, PHP 2014, 'Accurate and fast diagnostic algorithm for febrile urinary tract infections in humans' Netherlands Journal of Medicine, vol. 72, no. 7, pp. 356-362.

Accurate and fast diagnostic algorithm for febrile urinary tract infections in humans. / Gieteling, E.; van de Leur, J. J.C.M.; Stegeman, C. A.; Groeneveld, P. H.P.

In: Netherlands Journal of Medicine, Vol. 72, No. 7, 01.01.2014, p. 356-362.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Accurate and fast diagnostic algorithm for febrile urinary tract infections in humans

AU - Gieteling, E.

AU - van de Leur, J. J.C.M.

AU - Stegeman, C. A.

AU - Groeneveld, P. H.P.

PY - 2014/1/1

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N2 - Background: The urine dipstick that detects nitrite and leukocyte esterase, and urine sediment is commonly used to diagnose or exclude urinary tract infections (UTIs) as the source of infection in febrile patients admitted to the emergency department of Dutch hospitals. However, the diagnostic accuracy of the urine dipstick and urine sediment has never been studied in this specific situation.Methods: Urinary samples of 104 febrile consecutive patients were examined. Urine culture with ≥ 105 colonies/ ml of one or two known uropathogen was used as the gold standard. The diagnostic value of the urine dipstick, urine sediment and Gram stain at various cut-off points was determined and used to develop a new diagnostic algorithm. This algorithm was validated in a new group of sepsis patients based on systemic inflammatory response syndrome (SIRS) criteria. Results: A positive nitrite on the urine dipstick (specificity 99%) rules in UTI. This is the first step of our diagnostic algorithm. The second step is to exclude UTI by absence of bacteria in the urine sediment (sensitivity 94%). The thirdand last step is the number of leucocytes/high-power field (hpf) in the urine sediment. Less than 10 leucocytes/hpfmakes UTI unlikely whereas ≥ 10 leucocytes/hpf indicates UTI. In contrast to urine dipstick and/or urine sediment results alone, our algorithm showed both a high sensitivity (92%) and specificity (92%) and was validated in a new sepsis population. Conclusion: Our accurate and fast diagnostic algorithm, which combines the selective results of urine dipstick and urine sediment, can be easily used to diagnose UTI in febrile patients at the emergency department of Dutch hospitals.

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KW - Emergency department

KW - Fever

KW - Gram stain

KW - Urinary dipstick

KW - Urinary tract infection

KW - Urine sediment

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