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Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection?

Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection?. Date: 2002/6/28 黃錦鳳 / 黃玉純. Purpose. Determine the association of clear urine by visual inspection with the absence of significant bacteruria and to compare it with standard urinalysis. Methods.

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Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection?

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  1. Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection? Date: 2002/6/28 黃錦鳳/黃玉純

  2. Purpose • Determine the association of clear urine by visual inspection with the absence of significant bacteruria and to compare it with standard urinalysis.

  3. Methods • ED of Children’s Hospital Medical Center • < 21 years old children's • Information recorded • Duration of fever • Abdominal pain or flank pain • Dysuria, Frequency, urgency • Age • Sex • Catheterized or midstream

  4. Methods • Standardized technique ( visual inspection ) by 2 independent observers • 3 ml urine in red-topped blood tube • Held 1 cm from a white background with black printed 11-font text • Cloudy • 0.1 ml of 0.1 mol/L acetic acid solution to dissolve any phosphates • If there was a discrepncy in determination of clarity between these 2 individuals, the specimen was considered cloudy.

  5. Laboratory test • Nitrates, leukocyte esterase (LE), bacteria and WBC • Pyuria: ≥ 5 WBC/hpf • Culture positive • Catheterized: ≥ 104 CFU/ml • Midstream: ≥105 CFU/ml • Contamination: > 3 organisms

  6. Exclusion • Refered to the ED for evaluation of an abnormal U/A or positive U/C • Currently on antibiotics • Underlying medical problem requireing repeat catheterization,eg, neurogenic bladder • Unable to obtain an adequate volume of urine • Known to have an underlying renal and /or genitourinary abnormality

  7. Results • Patients samples 159 • age : 4 weeks to 19 years ( mean: 5.8 years ) • Sex : females-122(77%) / males-37(23%) • collection : catheterization -70(44%) med-steam -89(56%) visual : clear- 110(69%) / cloudy-49(31%)

  8. Results(2) • Culture : (+)-29(18%)--- clear : 3 cloudy : 26 • Culture : (-)-130(82%)--- clear : 107 cloudy : 23 • finding : clear urine on visual inspection had a negativepredictive value of 97%(107/110)

  9. Results(3) • 3 patients with clear urine who had a UTI (Table 2)--- 3 of 4 1. 2 patients <12months // WBC < 5 2. 1 patients 19-year // WBC >15 //abd. pain 3.D/U : (-) 4.Organism:E coli / K pneumoniae

  10. Discussion(1) • Up to 45% of children diagnosed with a will have a genitourinary abnormality requiring treatment. • Many previous studies have examined the utility of urine dipsticks and microscopy in the rapid detection of UTIs in children. • None of these tests have produced screening study with 100% sensitivity.

  11. Discussion(2) • Two studies • 376 urine samples age: 6weeks to 17 years 85% MSU 13% bag specimens 2%suprapubic aspiration NPV for the absence of a UTI of 100%

  12. Discussion(3) • 500 urine samples age: 6 weeks to 18 years 57% MSU 42% bag specimens 1% catheterization UTI was diagnosed in 15 of these patients the others were considered contaminants.

  13. Discussion(4) • Limitations to this study First using urine clarity as a screening tool requires accuracy in performing visual inspection. Second it is a preliminary study attempting to define a method that may reveal the absence of significant bacteruria.

  14. Conclusion • Clear urine on visual inspection cannot completely eliminate the possibility that a child has a UTI. • It is a reproducible test that offers the advantages of being simple, fast, and inexpensive. • The finding of clear urine should be considered a reasonable and relatively effective bedside screen for the presence of a UTI.

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