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Clinical usefulness of urine Gram stain for diagnosing urinary tract infections at the emergency department.

Authors :
Middelkoop SJM
de Joode AAE
van Pelt LJ
Kampinga GA
Ter Maaten JC
Stegeman CA
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.

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