Rapid dipstick test for diagnosis of urinary tract infection

The rapid dipstick test of urine leukocyte esterase (LE) activity and nitrite has not been studied fully in pediatric clinical situations. We investigated the usefulness of the dipstick LE and nitrite test in the screening of urinary tract infection (UTI) in pediatric patients. Ninety-two fresh urine samples were obtained from children suspected of having UTI. Leukocyte esterase activity and nitrite were measured in the urine specimens read by a photometer. Leukocytes were also counted on a disposable slide. Urine samples were examined for bacteriuria by the standard culture method. The results of the urine dipstick test of LE showed a close relationship with leukocyte counts on a counting chamber. Leukocyte esterase (-) indicated leukocyte counts of less than 10/uL with a probability of 97% (58/60). Of the 22 urine samples with significant bacteriuria diagnosed by standard urine culture, the nitrite test did not detect bacteriuria in 10. While the sensitivities of the dipstick tests of nitrite (+) and LE +/- or more for the diagnosis of significant bacteriuria were 55% (12/22) and 86% (19/22), respectively, the sensitivity and negative predictive value of the combined test were 100%. These results suggest that use of the dipstick test of LE and nitrite can avoid a large part of the cost incurred by urine culture and is useful for screening UTI in children.