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Accuracy of diagnostic tests to detect asymptomatic bacteriuria during pregnancy.
Obstet Gynecol. 2009 Feb; 113(2 Pt 1):346-52.OG

Abstract

OBJECTIVE

A dipslide is a plastic paddle coated with agar that is attached to a plastic cap that screws onto a sterile plastic vial. Our objective was to estimate the diagnostic accuracy of the dipslide culture technique to detect asymptomatic bacteriuria during pregnancy and to evaluate the accuracy of nitrate and leucocyte esterase dipslides for screening.

METHODS

This was an ancillary study within a trial comparing single-day with 7-day therapy in treating asymptomatic bacteriuria. Clean-catch midstream samples were collected from pregnant women seeking routine care. Positive and negative likelihood ratios and sensitivity and specificity for the culture-based dipslide to detect and chemical dipsticks (nitrites, leukocyte esterase, or both) to screen were estimated using traditional urine culture as the "gold standard."

RESULTS

: A total of 3,048 eligible pregnant women were screened. The prevalence of asymptomatic bacteriuria was 15%, with Escherichia coli the most prevalent organism. The likelihood ratio for detecting asymptomatic bacteriuria with a positive dipslide test was 225 (95% confidence interval [CI] 113-449), increasing the probability of asymptomatic bacteriuria to 98%; the likelihood ratio for a negative dipslide test was 0.02 (95% CI 0.01-0.05), reducing the probability of bacteriuria to less than 1%. The positive likelihood ratio of leukocyte esterase and nitrite dipsticks (when both or either one was positive) was 6.95 (95% CI 5.80-8.33), increasing the probability of bacteriuria to only 54%; the negative likelihood ratio was 0.50 (95% CI 0.45-0.57), reducing the probability to 8%.

CONCLUSION

A pregnant woman with a positive dipslide test is very likely to have a definitive diagnosis of asymptomatic bacteriuria, whereas a negative result effectively rules out the presence of bacteriuria. Dipsticks that measure nitrites and leukocyte esterase have low sensitivity for use in screening for asymptomatic bacteriuria during gestation.

CLINICAL TRIAL REGISTRATION

ISRCTN, isrctn.org, 1196608

LEVEL OF EVIDENCE

II.

Links

Aggregator Full Text

Authors+Show Affiliations

Mignini L
Centro Rosarino de Estudios Perinatales, Santa Fe, Argentina. lmignini@crep.com.ar
Carroli G
No affiliation info available
Abalos E
No affiliation info available
Widmer M
No affiliation info available
Amigot S
No affiliation info available
Nardin JM
No affiliation info available
Giordano D
No affiliation info available
Merialdi M
No affiliation info available
Arciero G
No affiliation info available
Del Carmen Hourquescos M
No affiliation info available
World Health Organization Asymptomatic Bacteriuria Trial Group
No affiliation info available

MeSH

BacteriuriaCarboxylic Ester HydrolasesColony Count, MicrobialFemaleHumansLikelihood FunctionsNitritesPredictive Value of TestsPregnancyPregnancy Complications, InfectiousReagent Kits, DiagnosticUrinalysisWorld Health Organization

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19155905

Citation

Mignini, Luciano, et al. "Accuracy of Diagnostic Tests to Detect Asymptomatic Bacteriuria During Pregnancy." Obstetrics and Gynecology, vol. 113, no. 2 Pt 1, 2009, pp. 346-52.
Mignini L, Carroli G, Abalos E, et al. Accuracy of diagnostic tests to detect asymptomatic bacteriuria during pregnancy. Obstet Gynecol. 2009;113(2 Pt 1):346-52.
Mignini, L., Carroli, G., Abalos, E., Widmer, M., Amigot, S., Nardin, J. M., Giordano, D., Merialdi, M., Arciero, G., & Del Carmen Hourquescos, M. (2009). Accuracy of diagnostic tests to detect asymptomatic bacteriuria during pregnancy. Obstetrics and Gynecology, 113(2 Pt 1), 346-52. https://doi.org/10.1097/AOG.0b013e318194f109
Mignini L, et al. Accuracy of Diagnostic Tests to Detect Asymptomatic Bacteriuria During Pregnancy. Obstet Gynecol. 2009;113(2 Pt 1):346-52. PubMed PMID: 19155905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of diagnostic tests to detect asymptomatic bacteriuria during pregnancy. AU - Mignini,Luciano, AU - Carroli,Guillermo, AU - Abalos,Edgardo, AU - Widmer,Mariana, AU - Amigot,Susana, AU - Nardin,Juan Manuel, AU - Giordano,Daniel, AU - Merialdi,Mario, AU - Arciero,Graciela, AU - Del Carmen Hourquescos,Maria, AU - ,, PY - 2009/1/22/entrez PY - 2009/1/22/pubmed PY - 2009/2/24/medline SP - 346 EP - 52 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 113 IS - 2 Pt 1 N2 - OBJECTIVE: A dipslide is a plastic paddle coated with agar that is attached to a plastic cap that screws onto a sterile plastic vial. Our objective was to estimate the diagnostic accuracy of the dipslide culture technique to detect asymptomatic bacteriuria during pregnancy and to evaluate the accuracy of nitrate and leucocyte esterase dipslides for screening. METHODS: This was an ancillary study within a trial comparing single-day with 7-day therapy in treating asymptomatic bacteriuria. Clean-catch midstream samples were collected from pregnant women seeking routine care. Positive and negative likelihood ratios and sensitivity and specificity for the culture-based dipslide to detect and chemical dipsticks (nitrites, leukocyte esterase, or both) to screen were estimated using traditional urine culture as the "gold standard." RESULTS: : A total of 3,048 eligible pregnant women were screened. The prevalence of asymptomatic bacteriuria was 15%, with Escherichia coli the most prevalent organism. The likelihood ratio for detecting asymptomatic bacteriuria with a positive dipslide test was 225 (95% confidence interval [CI] 113-449), increasing the probability of asymptomatic bacteriuria to 98%; the likelihood ratio for a negative dipslide test was 0.02 (95% CI 0.01-0.05), reducing the probability of bacteriuria to less than 1%. The positive likelihood ratio of leukocyte esterase and nitrite dipsticks (when both or either one was positive) was 6.95 (95% CI 5.80-8.33), increasing the probability of bacteriuria to only 54%; the negative likelihood ratio was 0.50 (95% CI 0.45-0.57), reducing the probability to 8%. CONCLUSION: A pregnant woman with a positive dipslide test is very likely to have a definitive diagnosis of asymptomatic bacteriuria, whereas a negative result effectively rules out the presence of bacteriuria. Dipsticks that measure nitrites and leukocyte esterase have low sensitivity for use in screening for asymptomatic bacteriuria during gestation. CLINICAL TRIAL REGISTRATION: ISRCTN, isrctn.org, 1196608 LEVEL OF EVIDENCE: II. SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/19155905/Accuracy_of_diagnostic_tests_to_detect_asymptomatic_bacteriuria_during_pregnancy_ L2 - https://doi.org/10.1097/AOG.0b013e318194f109 DB - PRIME DP - Unbound Medicine ER -