Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

OBJECTIVE: Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. METHODS: One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >10(5)  CFU/ml. RESULTS: In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells <5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. CONCLUSION: One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy.

Original publication

DOI

10.1111/tmi.12541

Type

Journal article

Journal

Trop Med Int Health

Publication Date

10/2015

Volume

20

Pages

1281 - 1289

Keywords

BLSE, antibiotic resistance, betalactamasas de amplio espectro, extended-spectrum β-lactamase, infección del tracto urinario, infection des voies urinaires, point-of-care tests, pruebas de diagnóstico en el punto de atención, resistencia a antibióticos, résistance aux antibiotiques, tests au point des soins, urinary tract infection, Adolescent, Adult, Aged, Anti-Bacterial Agents, Escherichia coli, Female, Humans, Male, Middle Aged, Outpatients, Reproducibility of Results, Retrospective Studies, Sensitivity and Specificity, Thailand, Urinary Tract Infections, Young Adult, beta-Lactamases