A recent study suggests that urine dipstick tests can help clinicians make quicker decisions regarding antibiotic treatment for urinary tract infections (UTIs) in infants, even before urine culture results are available.
The research, led by Kathryn M. Hunt, MD, and her team, evaluated the accuracy of the urine dipstick test compared to urinalysis for detecting UTIs in healthy infants. The infants, all with a fever of at least 38.0 °C (100.4 °F), were treated at five children’s hospitals in the United States and had urine cultures collected during their visits.
UTIs were defined as the growth of 50,000 or more colony-forming units per milliliter of a single bacterial uropathogen in a urine culture. The researchers used receiver operator characteristic (ROC) curve analysis to determine the best cutoff for white blood cell (WBC) counts in urine. The study then compared the results of positive urine dipstick tests (which detect leukocyte esterase or nitrite) to the WBC count for diagnosing UTI.
The study involved 9,387 febrile infants, with 11% diagnosed with a UTI. Those with UTIs were generally older, more often female, and had higher peak temperatures. The most common pathogen identified was Escherichia coli, present in 88.4% of cases.
In terms of diagnostic accuracy, the ROC curve analysis revealed that a WBC count of seven or more cells per high-power field (HPF) was the optimal cutoff. The results showed that a positive urine dipstick test had a higher sensitivity (90.2%) and specificity (92.6%) than a WBC count of seven or more cells per HPF, which had sensitivities of 83.9% and specificities of 87.0%.
These findings offer practical benefits for clinical settings, especially where immediate access to diagnostic labs may be limited. Dr. Hunt and her colleagues emphasized that point-of-care testing using urine dipsticks could speed up clinical decisions, potentially reducing patient wait times and overcrowding in emergency departments. This could lead to faster treatment, lower healthcare costs, and improved patient satisfaction.
Point-of-care tests like urine dipsticks are already used in primary care clinics and urgent care centers, where they can support quicker decisions and enhance care quality.
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