OBJECTIVE: To evaluate rapid diagnostic tests for bacteriuria in women with symptoms of urinary tract infection (UTI), and to analyse bacteriological and clinical findings in relation to host response to infection. DESIGN: Prospective study of symptomatic UTI in women. SETTING: Primary health care centres. PATIENTS: 819 women with signs and symptoms suggestive of UTI. MAIN OUTCOME MEASURES: History of UTI and clinical findings were recorded. After randomization but before antibiotic treatment, urine specimens were analysed for pyuria by sediment microscopy and for nitrite using a test strip, and cultures were performed. The systemic inflammatory response was assessed by C-reactive protein (CRP), erythrocyte sedimentation rate, and total white blood cell count. RESULTS: The combined use of tests for pyuria and nitrite resulted in a high sensitivity (0.93) and efficacy (0.85) when the prevalence of bacteriuria was 0.89. Escherichia coli and Staphylococcus saprophyticus accounted for 93% of the urinary isolates. Significantly more patients infected with S. saprophyticus than E. coli complained of dysuria (p < 0.05), frequency (p < 0.05) or flank pain (p < 0.01). CRP agreed best with the clinical diagnosis of acute pyelonephritis. CONCLUSIONS: In women with a high probability of bacteriuria, i.e. those with symptoms of lower UTI, examination for pyuria and urinary nitrite offers high diagnostic efficacy. If either or both tests are positive urine cultures can be omitted.
RCT Entities:
OBJECTIVE: To evaluate rapid diagnostic tests for bacteriuria in women with symptoms of urinary tract infection (UTI), and to analyse bacteriological and clinical findings in relation to host response to infection. DESIGN: Prospective study of symptomatic UTI in women. SETTING: Primary health care centres. PATIENTS: 819 women with signs and symptoms suggestive of UTI. MAIN OUTCOME MEASURES: History of UTI and clinical findings were recorded. After randomization but before antibiotic treatment, urine specimens were analysed for pyuria by sediment microscopy and for nitrite using a test strip, and cultures were performed. The systemic inflammatory response was assessed by C-reactive protein (CRP), erythrocyte sedimentation rate, and total white blood cell count. RESULTS: The combined use of tests for pyuria and nitrite resulted in a high sensitivity (0.93) and efficacy (0.85) when the prevalence of bacteriuria was 0.89. Escherichia coli and Staphylococcus saprophyticus accounted for 93% of the urinary isolates. Significantly more patients infected with S. saprophyticus than E. coli complained of dysuria (p < 0.05), frequency (p < 0.05) or flank pain (p < 0.01). CRP agreed best with the clinical diagnosis of acute pyelonephritis. CONCLUSIONS: In women with a high probability of bacteriuria, i.e. those with symptoms of lower UTI, examination for pyuria and urinary nitrite offers high diagnostic efficacy. If either or both tests are positive urine cultures can be omitted.
Authors: Kimberly A Kline; Molly A Ingersoll; Hailyn V Nielsen; Türkan Sakinc; Birgitta Henriques-Normark; Sören Gatermann; Michael G Caparon; Scott J Hultgren Journal: Infect Immun Date: 2010-02-22 Impact factor: 3.441
Authors: Sunny Park; Kathryn A Kelley; Evgeny Vinogradov; Robert Solinga; Christopher Weidenmaier; Yoshiki Misawa; Jean C Lee Journal: J Bacteriol Date: 2010-07-16 Impact factor: 3.490
Authors: Leonie G M Giesen; Gráinne Cousins; Borislav D Dimitrov; Floris A van de Laar; Tom Fahey Journal: BMC Fam Pract Date: 2010-10-24 Impact factor: 2.497
Authors: Walter L J M Devillé; Joris C Yzermans; Nico P van Duijn; P Dick Bezemer; Daniëlle A W M van der Windt; Lex M Bouter Journal: BMC Urol Date: 2004-06-02 Impact factor: 2.264