Diagnostic accuracy of urinary dipstick to exclude catheter-associated urinary tract infection in ICU patients: A reappraisal - Abstract

OBJECTIVES: We 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.

METHODS: This 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-).

RESULTS: Symptomatic 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).

CONCLUSIONS: Urinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia.

Written by:
Coman T, Troché G, Semoun O, Pangon B, Mignon F, Jacq G, Merceron S, Abbosh N, Laurent V, Guezennec P, Henry-Lagarrigue M, Revault-d'Allonnes L, Ben-Mokhtar H, Audibert J, Bruneel F, Resche-Rigon M, Bedos JP, Legriel S.   Are you the author?
Intensive Care Unit, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay cedex (78), France.

Reference: Infection. 2014 Mar 20. Epub ahead of print.
doi: 10.1007/s15010-014-0612-6

PubMed Abstract
PMID: 24647770