Dataset Information

Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study.

ABSTRACT:

Objective

To assess the test characteristics of a urine dipstick test in predicting a positive urine culture in an outpatient setting in Indonesia.

Design

Cross-sectional study.

Setting

Two outpatient clinics in Medan, Indonesia.

Participants

616 consecutively enrolled participants suspected of having a urinary tract infection.

Outcome measures

The primary outcome is the estimates of accuracy (sensitivity, specificity, predictive values) where urine culture is the reference test. The secondary outcome is the post-test probability of a positive urine culture.

Results

The optimal test characteristics were obtained when index test positivity was defined as any leucocyte esterase reaction and/or a nitrite reaction and reference test positivity was defined as a urine culture with a growth of at least 10³ colony-forming units/mL (sensitivity: 88.2% (95% CI 81.6 to 93.1), negative predictive value: 93.0% (95% CI 88.9 to 95.9)). The post-test probability of a positive urine culture after a negative urinary dipstick test was 7% in the obstetric/gynaecology clinic and 8% in the internal medicine clinic.

Conclusion

The use of a urine dipstick test in a rule-out strategy can reduce the need for urine culture and avoid the prescription of (ineffective) antibiotics in a non-urology outpatient setting.

SUBMITTER: Ginting F

PROVIDER: S-EPMC6119407 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study.

Ginting Franciscus F Sugianli Adhi Kristianto AK Kusumawati R Lia RL Parwati Ida I de Jong Menno D MD Schultsz Constance C van Leth Frank F

BMJ open 20180829 8

<h4>Objective</h4>To assess the test characteristics of a urine dipstick test in predicting a positive urine culture in an outpatient setting in Indonesia.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Two outpatient clinics in Medan, Indonesia.<h4>Participants</h4>616 consecutively enrolled participants suspected of having a urinary tract infection.<h4>Outcome measures</h4>The primary outcome is the estimates of accuracy (sensitivity, specificity, predictive values) where urine culture is ...[more]

PMID: 30158234

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Project description:ObjectiveTo assess the effectiveness of antibiotic treatment of women with symptoms of urinary tract infection but negative urine dipstick testing.DesignProspective, double blind, randomised, placebo controlled trial.SettingPrimary care, among a randomly selected group of general practitioners in Christchurch, New Zealand.Participants59 women aged 16-50 years presenting with a history of dysuria and frequency in whom a dipstick test of midstream urine was negative for both nitrites and leucocytes. Participants with complicated urinary tract infection were excluded.InterventionTrimethoprim 300 mg daily for three days or placebo.Main outcome measuresSelf reported diary of symptoms for seven days, recording the presence or absence of individual symptoms each day, followed by a structured telephone questionnaire after seven days. The main clinical outcome was resolution of dysuria at three and seven days and median time to resolution. Secondary outcomes were resolution of other symptoms.ResultsThe median time for resolution of dysuria was three days for trimethoprim compared with five days for placebo (P = 0.002). At day 3, five (24%) of patients in the treatment group had ongoing dysuria compared with 20 (74%) in the placebo group (P = 0.005). This difference persisted until day 7: two patients (10%) in the treatment group v 11 (41%) in the placebo group; P = 0.02). The number needed to treat was 4. The median duration of constitutional symptoms (feverishness, shivers) was reduced by four days.ConclusionsAlthough a negative dipstick test for leucocytes and nitrites accurately predicted absence of infection when standard microbiological definitions were used (negative predictive value 92%), it did not predict response to antibiotic treatment. Three days' treatment with trimethoprim significantly reduced dysuria in women whose urine dipstick test was negative. These results support the practice of empirical antibiotic use guided by symptoms. Balancing the competing interests of symptom relief and the minimisation of antibiotic use remains a dilemma-further research is needed to determine clinical predictors of response to antibiotics.

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Dataset Information

Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study.

Objective

Design

Setting

Participants

Outcome measures

Results

Conclusion

Publications

Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study.

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