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High Diagnostic Accuracy of Nitrite Test Paired with Urine Sediment can Reduce Unnecessary Antibiotic Therapy
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
Department of Medical Microbiology and Immunology, University of Gothenburg, Gothenburg, Sweden .
Umeå University, Faculty of Social Sciences, Department of Education.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
2015 (English)In: Open Microbiology Journal, ISSN 1874-2858, E-ISSN 1874-2858, Vol. 9, 150-159 p.Article in journal (Refereed) Published
Abstract [en]

Abstract: Background: Urinary tract infections (UTIs) are common bacterial infections dominated by lower UTI in women (LUTIW). Symptoms only are insufficient for diagnosis and accordingly, near patient diagnostic tests confidently confirming significant bacteriuria are desirable. The nitrite test (NIT) has low sensitivity, while bacterial and leukocyte counts disjunctively paired in urine sediment microscopy (SED) have high sensitivity. Similar symptomatic cure rates are found post antibiotic vs. placebo therapy in patients with negative cultures. Consequently, prescription on symptoms only implies unnecessary antibiotic therapy. Aims: to evaluate the diagnostic outcomes of NIT, SED and NIT disjunctively paired with SED (NIT+SED) vs. urine culture, with special focus on bladder incubation time (BIT), and to assess if NIT+SED can reduce unnecessary antibiotic therapy. Methods: A diagnostic, primary care, multicentre study including 1070 women with symptoms suggestive of lower UTI. Results: Significant bacteriuria was found in 77%. The BIT highly influenced the diagnostic outcomes and the optimal duration was 4h with sensitivity of 66, 90 and 95% for NIT, SED and NIT+SED, respectively. SED performed only in NIT negative specimens could reduce unnecessary antibiotics by 10% vs. prescription on symptoms only. The number needed to test with SED to reduce one unnecessary antibiotic course was five patients at BIT 4h and six patients at 3h or overall. Conclusion: The BIT highly influences the diagnostic outcomes with the highest accuracy of NIT+SED. Diagnosis of LUTIW with NIT+SED can reduce unnecessary antibiotic therapy and subsequently decrease antimicrobial resistance. Trial registration: The Swedish Medical Product Agency 1995 03 01:151:01783/94.

Place, publisher, year, edition, pages
2015. Vol. 9, 150-159 p.
Keyword [en]
Antibiotic resistance, bacteria, bladder incubation time, diagnosis, dipstick test, leukocytes, primary care, urinary tract infection
National Category
Clinical Medicine
URN: urn:nbn:se:umu:diva-125212DOI: 10.2174/1874285801509010150OAI: diva2:967359
Available from: 2016-09-08 Created: 2016-09-08 Last updated: 2016-11-15Bibliographically approved

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