Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study.

Autor:	Kristensen LH; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark., Winther R; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark., Colding-Jørgensen JT; Odense Universitetshospital, Odense, Denmark., Pottegård A; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark., Nielsen H; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark., Bodilsen J; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark jacob.bodilsen@rn.dk.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Jazyk:	angličtina
Zdroj:	BMJ evidence-based medicine [BMJ Evid Based Med] 2024 Jul 12. Date of Electronic Publication: 2024 Jul 12.
DOI:	10.1136/bmjebm-2024-112920
Abstrakt:	Objective: To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals. Design: Prospective population-based cohort study. Setting: North Denmark. Participants: All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021. Main Outcome Measures: UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite. Results: Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. Modified Poisson regression yielded an adjusted relative risk of 4.41 (95% CI 2.40 to 8.11) for empirical antibiotics for UTI in participants without specific UTI symptoms and a positive dipstick. Conclusions: Dipsticks yielded limited clinical decision support compared with a symptom-driven approach in this study and were independently associated with excess antibiotics for UTI. Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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