Predictability of urinalysis parameters in the diagnosis of urinary tract infection: a case study

Early diagnostic strategies to rule out uncomplicated urinary tract infections (UTI) or test of exclusion could significantly improve patient management in addition to providing optimal cost-effectiveness. We evaluated the predictability of dipstick parameters, with particular emphasis on leukocyte esterase (LE) and nitrite (NT) tests and microscopic urine sediment analysis as predictors of urinary tract infection in the setting of an urban university hospital. A total of 9,845 culture positive urine samples (7,095 females, 2,750 males; 8,938 clean catch, 907 catheterized specimens) collected over a period of twelve months from all patients seen at Temple University Hospital, Philadelphia, were included in this retrospective study. Dipstick and urinalysis data were independently correlated and compared with positive culture results. Either individually or in combination, LE and NT were positive in 30% (2,912/9,845), while both LE and NT were negative in 70% (6,933/9,845) of the total culture positive urine samples. There was no correlation of several other measured variables to culture positive urine samples. This study demonstrates that the uses of LE and/or NT are poor screening parameters as predictors of UTI, in the absence of additional clinical information.