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Can routine automated urinalysis reduce culture requests?
Clin Biochem. 2013 Sep; 46(13-14):1285-9.CB

Abstract

OBJECTIVES

There are a substantial number of unnecessary urine culture requests. We aimed to investigate whether urine dipstick and microscopy results could accurately rule out urinary tract infection (UTI) without urine culture.

DESIGN AND METHODS

The study included a total of 32,998 patients (11,928 men and 21,070 women, mean age: 39 ± 32 years) with a preliminary diagnosis of UTI and both urinalysis and urinary culture were requested. All urine cultures were retrospectively reviewed; association of culture positivity with a positive urinalysis result for leukocyte esterase (LE) and nitrite in chemical analysis and pyuria (WBC) and bacteriuria in microscopy was determined. Diagnostic performance of urinalysis parameters for detection of UTI was evaluated.

RESULTS

In total, 758 (2.3%) patients were positive by urine culture. Out of these culture positive samples, ratios of positive dipstick results for LE and nitrite were 71.0% (n=538) and 17.7% (n=134), respectively. The positive microscopy results for WBC and bacteria were 68.2% (n=517) and 78.8% (n=597), respectively. Negative predictive values for LE, nitrite, bacteriuria and WBC were very close to 100%.

CONCLUSIONS

Most of the samples have no or insignificant bacterial growth. Urine dipstick and microscopy can accurately rule out UTI. Automated urinalysis is a practicable and faster screening test which may prevent unnecessary culture requests for majority of patients.

Authors+Show Affiliations

Department of Medical Biochemistry, Ankara Training and Research Hospital, Ministry of Health, Cebeci, Ankara 06340, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23810583

Citation

Kayalp, Damla, et al. "Can Routine Automated Urinalysis Reduce Culture Requests?" Clinical Biochemistry, vol. 46, no. 13-14, 2013, pp. 1285-9.
Kayalp D, Dogan K, Ceylan G, et al. Can routine automated urinalysis reduce culture requests? Clin Biochem. 2013;46(13-14):1285-9.
Kayalp, D., Dogan, K., Ceylan, G., Senes, M., & Yucel, D. (2013). Can routine automated urinalysis reduce culture requests? Clinical Biochemistry, 46(13-14), 1285-9. https://doi.org/10.1016/j.clinbiochem.2013.06.015
Kayalp D, et al. Can Routine Automated Urinalysis Reduce Culture Requests. Clin Biochem. 2013;46(13-14):1285-9. PubMed PMID: 23810583.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can routine automated urinalysis reduce culture requests? AU - Kayalp,Damla, AU - Dogan,Kubra, AU - Ceylan,Gozde, AU - Senes,Mehmet, AU - Yucel,Dogan, Y1 - 2013/06/25/ PY - 2013/03/03/received PY - 2013/06/13/revised PY - 2013/06/14/accepted PY - 2013/7/2/entrez PY - 2013/7/3/pubmed PY - 2014/3/19/medline KW - Bacteriuria KW - CFU KW - Culture KW - DOR KW - Data mining KW - Evidence-based laboratory medicine KW - LE KW - LR KW - NPV KW - PPV KW - ROC KW - Rational test requesting KW - UTI KW - Urinalysis KW - Urinary tract infection KW - WBC KW - colony forming units KW - diagnostic odds ratio KW - high power field KW - hpf KW - leukocyte esterase KW - likelihood ratio KW - negative predictive value KW - positive predictive value KW - receiver operating characteristics KW - urinary tract infection KW - white blood cell SP - 1285 EP - 9 JF - Clinical biochemistry JO - Clin Biochem VL - 46 IS - 13-14 N2 - OBJECTIVES: There are a substantial number of unnecessary urine culture requests. We aimed to investigate whether urine dipstick and microscopy results could accurately rule out urinary tract infection (UTI) without urine culture. DESIGN AND METHODS: The study included a total of 32,998 patients (11,928 men and 21,070 women, mean age: 39 ± 32 years) with a preliminary diagnosis of UTI and both urinalysis and urinary culture were requested. All urine cultures were retrospectively reviewed; association of culture positivity with a positive urinalysis result for leukocyte esterase (LE) and nitrite in chemical analysis and pyuria (WBC) and bacteriuria in microscopy was determined. Diagnostic performance of urinalysis parameters for detection of UTI was evaluated. RESULTS: In total, 758 (2.3%) patients were positive by urine culture. Out of these culture positive samples, ratios of positive dipstick results for LE and nitrite were 71.0% (n=538) and 17.7% (n=134), respectively. The positive microscopy results for WBC and bacteria were 68.2% (n=517) and 78.8% (n=597), respectively. Negative predictive values for LE, nitrite, bacteriuria and WBC were very close to 100%. CONCLUSIONS: Most of the samples have no or insignificant bacterial growth. Urine dipstick and microscopy can accurately rule out UTI. Automated urinalysis is a practicable and faster screening test which may prevent unnecessary culture requests for majority of patients. SN - 1873-2933 UR - https://www.unboundmedicine.com/medline/citation/23810583/Can_routine_automated_urinalysis_reduce_culture_requests L2 - https://linkinghub.elsevier.com/retrieve/pii/S0009-9120(13)00292-0 DB - PRIME DP - Unbound Medicine ER -