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

Autor:	Middelkoop SJM; Department of Internal Medicine, division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., de Joode AAE; Department of Internal Medicine, division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., van Pelt LJ; Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Kampinga GA; Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Ter Maaten JC; Department of Acute Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Stegeman CA; Department of Internal Medicine, division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jazyk:	angličtina
Zdroj:	Infectious diseases (London, England) [Infect Dis (Lond)] 2024 Dec; Vol. 56 (12), pp. 1093-1101. Date of Electronic Publication: 2024 Aug 16.
DOI:	10.1080/23744235.2024.2389478
Abstrakt:	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. Objective: We studied the GS performance to clarify its clinical utility at the ED. 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. 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)). 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.
Databáze:	MEDLINE
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