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Clinical usefulness of urine Gram stain for diagnosing urinary tract infections at the emergency department.
- Source :
-
Infectious diseases (London, England) [Infect Dis (Lond)] 2024 Dec; Vol. 56 (12), pp. 1093-1101. Date of Electronic Publication: 2024 Aug 16. - Publication Year :
- 2024
-
Abstract
- Background: Diagnosis of urinary tract infections (UTIs) is a frequent challenge at the emergency department (ED). The clinical usefulness of the urine Gram stain (GS) is uncertain.<br />Objective: We studied the GS performance to clarify its clinical utility at the ED.<br />Methods: Urine dipstick (UD), automated urinalysis (UF-1000 i ), GS and urine culture (UC) were performed in a cohort of consecutive adults presenting at the ED suspected of a UTI. GS performance was assessed and compared to UD and UF-1000 i.<br />Results: A UTI diagnosis was established in 487/1358 (35.9%) episodes. Sensitivity and specificity for 'many' GS leucocytes was 33.7% and 95.4%; for 'many' GS bacteria 51.3% and 91.0%. GS diagnostic performance by ROC analysis was 0.796 for leucocytes and 0.823 for bacteria. GS bacteria performed better than UD nitrite comparable to UF-1000 i bacteria. GS leucocytes underperformed compared to UD leucocyte esterase and UF-1000 i leucocytes. UC was positive in 455 episodes. GS correctly predicted urine culture of gram-negative rods (PPV 84.6%). Prediction was poor for gram-positive bacteria (PPV 38.4% (cocci), 1.0% (rods)).<br />Conclusion: With the exception of a moderate prediction of gram-negative bacteria in the UC, urine GS does not improve UTI diagnosis at the ED compared to other urine parameters.
- Subjects :
- Humans
Male
Female
Middle Aged
Adult
Aged
Aged, 80 and over
Young Adult
Urine microbiology
Staining and Labeling methods
Urinary Tract Infections diagnosis
Urinary Tract Infections microbiology
Urinary Tract Infections urine
Emergency Service, Hospital
Gentian Violet
Phenazines
Urinalysis methods
Sensitivity and Specificity
Subjects
Details
- Language :
- English
- ISSN :
- 2374-4243
- Volume :
- 56
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Infectious diseases (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 39148494
- Full Text :
- https://doi.org/10.1080/23744235.2024.2389478