Diagnostic accuracy of urinary dipstick to exclude catheter-associated urinary tract infection in ICU patients: a reappraisal View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-03-20

AUTHORS

T. Coman, G. Troché, O. Semoun, B. Pangon, F. Mignon, G. Jacq, S. Merceron, N. Abbosh, V. Laurent, P. Guezennec, M. Henry-Lagarrigue, L. Revault-d’Allonnes, H. Ben-Mokhtar, J. Audibert, F. Bruneel, M. Resche-Rigon, J.-P. Bedos, S. Legriel

ABSTRACT

ObjectivesWe wanted to assess the diagnostic accuracy of urinary dipstick testing in excluding catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients with fever or hypothermia.MethodsThis was a prospective observational cohort study in a medical-surgical ICU. Patients with new-onset fever >38.3 °C or hypothermia <36 °C at least 48 h after urinary catheter insertion were included over a 2-year period. At each episode, a urinary dipstick test and a urine culture were performed as the criterion standard. Extensive microbiological investigations for extra-urinary infections were performed also. The performances of various urinary dipstick result combinations in ruling out CAUTI were compared based on the likelihood ratios (LR+ and LR−).ResultsSymptomatic CAUTI was diagnosed in 31 (24.4 %) of the 127 included patients (195 episodes of fever or hypothermia). LR+ was best for combined leukocyte esterase-positive and nitrite-positive dipstick results (overall population: 14.91; 95 % confidence interval [95 % CI], 5.53–40.19; patients without urinary symptoms: 15.63; 95 % CI, 5.76–42.39). LR− was best for either leukocyte esterase-positive or nitrite-positive dipstick results (overall population: 0.41; 95 % CI, 0.57–0.65; patients without urinary symptoms, 0.36; 95 % CI, 0.21–0.60).ConclusionsUrinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia. More... »

PAGES

661-668

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s15010-014-0612-6

DOI

http://dx.doi.org/10.1007/s15010-014-0612-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1021606351

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24647770


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    "description": "ObjectivesWe wanted to assess the diagnostic accuracy of urinary dipstick testing in excluding catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients with fever or hypothermia.MethodsThis was a prospective observational cohort study in a medical-surgical ICU. Patients with new-onset fever >38.3\u00a0\u00b0C or hypothermia <36\u00a0\u00b0C at least 48\u00a0h after urinary catheter insertion were included over a 2-year period. At each episode, a urinary dipstick test and a urine culture were performed as the criterion standard. Extensive microbiological investigations for extra-urinary infections were performed also. The performances of various urinary dipstick result combinations in ruling out CAUTI were compared based on the likelihood ratios (LR+ and LR\u2212).ResultsSymptomatic CAUTI was diagnosed in 31 (24.4\u00a0%) of the 127 included patients (195 episodes of fever or hypothermia). LR+ was best for combined leukocyte esterase-positive and nitrite-positive dipstick results (overall population: 14.91; 95\u00a0% confidence interval [95\u00a0% CI], 5.53\u201340.19; patients without urinary symptoms: 15.63; 95\u00a0% CI, 5.76\u201342.39). LR\u2212 was best for either leukocyte esterase-positive or nitrite-positive dipstick results (overall population: 0.41; 95\u00a0% CI, 0.57\u20130.65; patients without urinary symptoms, 0.36; 95\u00a0% CI, 0.21\u20130.60).ConclusionsUrinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia.", 
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27 schema:description ObjectivesWe wanted to assess the diagnostic accuracy of urinary dipstick testing in excluding catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients with fever or hypothermia.MethodsThis was a prospective observational cohort study in a medical-surgical ICU. Patients with new-onset fever >38.3 °C or hypothermia <36 °C at least 48 h after urinary catheter insertion were included over a 2-year period. At each episode, a urinary dipstick test and a urine culture were performed as the criterion standard. Extensive microbiological investigations for extra-urinary infections were performed also. The performances of various urinary dipstick result combinations in ruling out CAUTI were compared based on the likelihood ratios (LR+ and LR−).ResultsSymptomatic CAUTI was diagnosed in 31 (24.4 %) of the 127 included patients (195 episodes of fever or hypothermia). LR+ was best for combined leukocyte esterase-positive and nitrite-positive dipstick results (overall population: 14.91; 95 % confidence interval [95 % CI], 5.53–40.19; patients without urinary symptoms: 15.63; 95 % CI, 5.76–42.39). LR− was best for either leukocyte esterase-positive or nitrite-positive dipstick results (overall population: 0.41; 95 % CI, 0.57–0.65; patients without urinary symptoms, 0.36; 95 % CI, 0.21–0.60).ConclusionsUrinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia.
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