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Steve J Chadba - One of the best experts on this subject based on the ideXlab platform.
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conversion of urine protein creatinine ratio or urine Dipstick protein to urine albumin creatinine ratio for use in chronic kidney disease screening and prognosis an individual participant based meta analysis
Annals of Internal Medicine, 2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Background Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or Dipstick protein is often measured instead. Objective To develop equations for converting urine protein-creatinine ratio (PCR) and Dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging. Design Individual participant-based meta-analysis. Setting 12 research and 21 clinical cohorts. Participants 919 383 adults with same-day measures of ACR and PCR or Dipstick protein. Measurements Equations to convert urine PCR and Dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g). Results Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine Dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR. Limitation Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample. Conclusion Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine Dipstick protein may help in CKD screening, staging, and prognosis. Primary funding source National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
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conversion of urine protein creatinine ratio or urine Dipstick protein to urine albumin creatinine ratio for use in chronic kidney disease screening and prognosis
Annals of Internal Medicine, 2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), but total urine protein or Dipstick protein is often measured instead. This analysis presents eq...
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Conversion of Urine Protein–Creatinine Ratio or Urine Dipstick Protein to Urine Albumin–Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis
2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Background: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or Dipstick protein is often measured instead.Objective: To develop equations for converting urine protein creatinine ratio (PCR) and Dipstick protein to urine albumin creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.Design: Individual participant–based meta-analysis.Setting: 12 research and 21 clinical cohorts.Participants: 919 383 adults with same-day measures of ACR and PCR or Dipstick protein.Measurements: Equations to convert urine PCR and Dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).Results: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine Dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.Limitation: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.Conclusion: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine Dipstick protein may help in CKD screening, staging, and prognosis.
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Conversion of urine protein-creatinine ratio or urine Dipstick to urine albumin-creatinine ratio for use in CKD screening and prognosis
'American College of Physicians', 2020Co-Authors: Sumida K, Morga E Grams, Shoshana H Allew, Nadkarni G, Sang Y, Coresh J, Matsushita K, Surapaneni A, Unskill N, Steve J ChadbaAbstract:Background: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or Dipstick protein is often measured instead. Objective: To develop equations for converting urine protein–creatinine ratio (PCR) and Dipstick protein to urine albumin–creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging. Design: Individual participant–based meta-analysis. Setting: 12 research and 21 clinical cohorts. Participants: 919 383 adults with same-day measures of ACR and PCR or Dipstick protein. Measurements: Equations to convert urine PCR and Dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g). Results: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine Dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR. Limitation: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample. Conclusion: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine Dipstick protein may help in CKD screening, staging, and prognosis. Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation
David A Sack - One of the best experts on this subject based on the ideXlab platform.
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alkaline peptone water enrichment with a Dipstick test to quickly detect and monitor cholera outbreaks
BMC Infectious Diseases, 2017Co-Authors: Godfrey Wire, Christopher Garimoi Orach, Dauda Abdallah, Amanda K Debes, Atek Kagirita, Malathi Ram, David A SackAbstract:Detection, confirmation and monitoring of cholera outbreaks in many developing countries including Uganda is a big challenge due to lack of the required resources and the time the test takes. Culture method which takes 24–48 h to get the feedback and requires highly skilled laboratory staff plus other complex resources is the standard test. This study evaluated the new cholera rapid detection method that relies on Crystal VC Dipsticks after enrichment with alkaline peptone water (APW) against the culture method for monitoring the progress of cholera outbreaks in rural setting. We conducted the study between March and June 2015. Fresh stool samples and rectal swabs were incubated in 1% APW for 6 h at room temperature before testing with RDT following the manufacturer’s instruction. The same stool sample was cultured to isolate V. cholerae in the standard manner. We also reviewed patient registers to epidemiologically describe the cholera epidemic. We tested stool from 102 consenting suspected cholera patients reporting during daytime at Bwera Hospital (n = 69), Kilembe Mines Hospital (n = 4) and Kinyabwama Health Centre (n = 29). Ninety one (91) samples were positive and nine samples were negative according to both methods. One (1) sample was positive only by Dipstick and one sample was positive only by culture (sensitivity of 99%, specificity of 90%, Positive Predictive Value of 99% and Negative Predictive Value of 90%). Overall, 146 suspected cholera cases and two deaths, (case fatality rate of 1.36%) were recorded during the study period. Among the cases aged 1–9 years, 63% (50/79) were males while in those aged 20–49 years, 76% (34/45) were females. Our findings showed that the modified Dipstick test after enrichment with 1% APW had high level of accuracy in detection of V. cholerae and is quick, affordable alternative cholera outbreak monitoring tool in resource constrained settings. However, culture method should remain for cholera epidemic confirmation, for monitoring of antibiotic sensitivity and for production of pure isolates for molecular characterization. Further studies should be done to better understand the observed age and sex case distribution, in Kasese district.
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adaptation of a simple Dipstick test for detection of vibrio cholerae o1 and o139 in environmental water
Frontiers in Microbiology, 2013Co-Authors: Subhra Chakraborty, Munirul Alam, Heather Scobie, David A SackAbstract:The presence of Vibrio cholerae in the environment is key to understanding the epidemiology of cholera. The gold standard for laboratory confirmation of V. cholerae from water is a culture method, but this requires laboratory infrastructure. A rapid diagnostic test that is simple, inexpensive, and can be deployed widely would be useful for confirming V. cholerae in samples of environmental water. Here, we evaluated a Dipstick test to detect V. cholerae O1 and O139 from environmental water samples in spiked samples and under field conditions. When environmental water samples were incubated in alkaline peptone water for 24 h at room temperature, samples spiked with <10 CFU could be detected using the Dipstick test. When compared to culture, the test was 89% sensitive and 100% specific with environmental samples.
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one step immunochromatographic Dipstick tests for rapid detection of vibrio cholerae o1 and o139 in stool samples
Clinical and Vaccine Immunology, 2003Co-Authors: Faridabano Nato, Alai Outonnie, Minoarisoa Rajeriso, P Grosjea, Sylvie Dartevelle, Alai Guenole, N A Huiya, David A Sack, G Nai, Jeanmichel FournieAbstract:We describe the development and evaluation of a rapid diagnostic test for Vibrio cholerae O1 and O139 based on lipopolysaccharide detection using gold particles. The specificity ranged between 84 and 100%. The sensitivity of the Dipsticks ranged from 94.2 to 100% when evaluated with stool samples obtained in Madagascar and Bangladesh. The Dipstick can provide a simple tool for epidemiological surveys.
Keiichi Sumida - One of the best experts on this subject based on the ideXlab platform.
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conversion of urine protein creatinine ratio or urine Dipstick protein to urine albumin creatinine ratio for use in chronic kidney disease screening and prognosis
Annals of Internal Medicine, 2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), but total urine protein or Dipstick protein is often measured instead. This analysis presents eq...
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conversion of urine protein creatinine ratio or urine Dipstick protein to urine albumin creatinine ratio for use in chronic kidney disease screening and prognosis an individual participant based meta analysis
Annals of Internal Medicine, 2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Background Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or Dipstick protein is often measured instead. Objective To develop equations for converting urine protein-creatinine ratio (PCR) and Dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging. Design Individual participant-based meta-analysis. Setting 12 research and 21 clinical cohorts. Participants 919 383 adults with same-day measures of ACR and PCR or Dipstick protein. Measurements Equations to convert urine PCR and Dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g). Results Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine Dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR. Limitation Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample. Conclusion Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine Dipstick protein may help in CKD screening, staging, and prognosis. Primary funding source National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
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Conversion of Urine Protein–Creatinine Ratio or Urine Dipstick Protein to Urine Albumin–Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis
2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Background: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or Dipstick protein is often measured instead.Objective: To develop equations for converting urine protein creatinine ratio (PCR) and Dipstick protein to urine albumin creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.Design: Individual participant–based meta-analysis.Setting: 12 research and 21 clinical cohorts.Participants: 919 383 adults with same-day measures of ACR and PCR or Dipstick protein.Measurements: Equations to convert urine PCR and Dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).Results: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine Dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.Limitation: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.Conclusion: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine Dipstick protein may help in CKD screening, staging, and prognosis.
Josef Coresh - One of the best experts on this subject based on the ideXlab platform.
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conversion of urine protein creatinine ratio or urine Dipstick protein to urine albumin creatinine ratio for use in chronic kidney disease screening and prognosis an individual participant based meta analysis
Annals of Internal Medicine, 2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Background Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or Dipstick protein is often measured instead. Objective To develop equations for converting urine protein-creatinine ratio (PCR) and Dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging. Design Individual participant-based meta-analysis. Setting 12 research and 21 clinical cohorts. Participants 919 383 adults with same-day measures of ACR and PCR or Dipstick protein. Measurements Equations to convert urine PCR and Dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g). Results Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine Dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR. Limitation Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample. Conclusion Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine Dipstick protein may help in CKD screening, staging, and prognosis. Primary funding source National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
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conversion of urine protein creatinine ratio or urine Dipstick protein to urine albumin creatinine ratio for use in chronic kidney disease screening and prognosis
Annals of Internal Medicine, 2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), but total urine protein or Dipstick protein is often measured instead. This analysis presents eq...
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Conversion of Urine Protein–Creatinine Ratio or Urine Dipstick Protein to Urine Albumin–Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis
2020Co-Authors: Keiichi Sumida, Girish N Nadkarni, Morga E Grams, Yingying Sang, Shoshana H Allew, Josef Coresh, Kunihiro Matsushita, Aditya Surapaneni, Nigel Unskill, Steve J ChadbaAbstract:Background: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or Dipstick protein is often measured instead.Objective: To develop equations for converting urine protein creatinine ratio (PCR) and Dipstick protein to urine albumin creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.Design: Individual participant–based meta-analysis.Setting: 12 research and 21 clinical cohorts.Participants: 919 383 adults with same-day measures of ACR and PCR or Dipstick protein.Measurements: Equations to convert urine PCR and Dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).Results: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine Dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.Limitation: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.Conclusion: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine Dipstick protein may help in CKD screening, staging, and prognosis.
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clinical practice guidelines for chronic kidney disease in adults part ii glomerular filtration rate proteinuria and other markers
American Family Physician, 2004Co-Authors: Cynda Ann Johnson, Josef Coresh, Andrew S Levey, Adeera Levin, Garabed EknoyanAbstract:The Kidney Disease Outcome Quality Initiative of the National Kidney Foundation published clinical practice guidelines on chronic kidney disease in February 2002. Of the 15 guidelines, the first six are of greatest relevance to family physicians. Part II of this two-part review covers guidelines 4, 5, and 6. Glomerular filtration rate is the best overall indicator of kidney function. It is superior to the serum creatinine level, which varies with age, sex, and race and often does not reflect kidney function accurately. The glomerular filtration rate can be estimated using prediction equations that take into account the serum creatinine level and some or all of specific variables (age, sex, race, body size). In many patients, estimates of the glomerular filtration rate can replace 24-hour urine collections for creatinine clearance measurements. Urine Dipsticks generally are acceptable for detecting proteinuria. To quantify proteinuria, the ratio of protein or albumin to creatinine in an untimed (spot) urine sample is an accurate alternative to measurement of protein excretion in a 24-hour urine collection. Patients with persistent proteinuria have chronic kidney disease. Other techniques for evaluating patients with chronic kidney disease include examination of urinary sediment, urine Dipstick testing for red and white blood cells, and imaging studies of the kidneys (especially ultrasonography). These techniques also can help determine the underlying cause of chronic kidney disease. Family physicians should weigh the value of the National Kidney Foundation guidelines for their clinical practice based on the strength of evidence and perceived cost-effectiveness until additional evidence becomes available on the usefulness of the recommended quality indicators.
Paul Froom - One of the best experts on this subject based on the ideXlab platform.
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no need for a urine culture in elderly hospitalized patients with a negative Dipstick test result
European Journal of Clinical Microbiology & Infectious Diseases, 2018Co-Authors: Zvi Shimoni, Vered Hermush, Joseph Glick, Paul FroomAbstract:: To determine the clinical utility/disutility of canceling urine cultures in elderly patients with a negative Dipstick. The cohort included consecutive patients aged ≥ 65 years hospitalized in internal medicine departments with an admission urinalysis and urine culture (January 1, 2014 to December 31, 2016). We calculated the sensitivity of the Dipstick (either a trace leukocyte esterase or a positive nitrite test result) to detect patients with bacteriuria, and the decrease in urine cultures resulting from cancelation in patients with a negative Dipstick. We reviewed the charts of patients with a positive culture but negative Dipstick to determine if they received appropriate antibiotic therapy and if the culture results had clinical utility, defined as changes in antibiotic therapy made according to culture results in a patient who did not respond to initial antibiotic therapy. The sensitivity of the Dipstick for bacteriuria was 90.8% (95% CI, 89.6-92.0%). Of the 210 patients with a positive culture but negative Dipstick, 132 (62.9%) had a diagnosis clearly outside the urinary tract. Thirty-five patients (16.7%) received inappropriate differential antibiotic therapy. Urine cultures did not have clinical utility and canceling urine cultures in those with a negative Dipstick would result in a 41.5% (95% CI, 40.3-42.7%) decrease in urine cultures. We conclude that canceling orders for urine cultures in the elderly patient with a negative Dipstick did not have clinical disutility and would decrease inappropriate antibiotic therapy. Extrapolation to other settings is dependent on urinalysis methodology, patient selection, and physician ordering and treatment behaviors.
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sensitivity of the Dipstick in detecting bacteremic urinary tract infections in elderly hospitalized patients
PLOS ONE, 2017Co-Authors: Zvi Shimoni, Vered Hermush, Joseph Glick, Paul FroomAbstract:Background The sensitivity of the Dipstick in elderly patients with a suspected urinary tract infection (UTI) is unclear because of the inclusion of patients with urine contamination or asymptomatic bacteriuria in previous studies. Methods We selected consecutive patients aged 65 years or older hospitalized in internal medicine departments with bacteremic UTI (same organism in blood and urine cultures) minimizing misclassifications. The false positive rate was determined in consecutive patients with negative culture results. A positive Dipstick was a test result with a trace leukocyte esterase and/or nitrite positivity. Bacteriuria was the growth of at least 105 colony-forming units per milliliter of urine. Results Of 20,555 consecutive patients, 228 had a bacteremic UTI, and 4069 a negative culture result. The sensitivity of the Dipstick was 96.9% (95% CI—93.7–98.6) with a false positive rate of 42.4% (95% CI, 41.0–43.8) in those with a negative culture result. Conclusions In elderly hospitalized patients with a bacteremic UTI, the Dipstick urinalysis is highly sensitive, much higher than reported previously in studies of UTIs in the elderly. It is unclear whether the observed high sensitivity of the Dipstick was due to the exclusion of patients with asymptomatic bacteriuria or to spectrum bias. Studies of the clinical utility/disutility of using a negative Dipstick to rule out a urinary tract infection are warranted.