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Multicenter Study
. 2022 Mar 7;22(1):187.
doi: 10.1186/s12877-022-02866-2.

Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study

Katrien Latour  1   2 , Jan De Lepeleire  3 , Boudewijn Catry  4   5 , Frank Buntinx  3   6
Affiliations
Multicenter Study

Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study

Katrien Latour et al. BMC Geriatr. .

Abstract

Background: Urinary tract infections (UTIs) are one of the most common infections in nursing homes (NHs). A high error rate of a UTI diagnosis based solely on clinical criteria is to be expected in older persons as they often present infections in an atypical way. A study was set up to assess the diagnostic value of signs/symptoms and urine dipstick testing in identifying UTIs in NH residents and to explore whether C-reactive protein (CRP) measured by point-of-care testing (POCT) can help in the diagnosis.

Methods: During a three month prospective multicentre study, urine sampling for culture, POCT CRP and urinary dipstick testing were performed in each NH resident with a suspected UTI. UTIs were defined according to Stone et al., i.e. criteria based upon the presence of a set of signs/symptoms and a positive urine culture.

Results: Eleven NHs and 1 263 residents participated. Sixteen out of 137 recorded UTI suspicions were confirmed. Acute dysuria (positive likelihood ratio (LR +): 7.56, 95% confidence interval (CI): 3.94-14.5) and acute suprapubic pain (LR + : 11.4, 95% CI: 3.58-35.9) were found to be significant predictors. The combined nitrite and leucocyte esterase urine dipstick test (one or both positive) had a 96.0% negative predictive value (95% CI: 80.5-99.3%). The sensitivity of a positive CRP test (≥ 5 mg/L) was 60.0% (95% CI: 32.3-83.7%). Antimicrobials were prescribed in 60.2% of suspected but unconfirmed UTIs and in 92.3% of confirmed UTIs.

Conclusions: Using a stringent definition, only 11.7% of our suspicions were confirmed. Besides acute dysuria and suprapubic pain, we were not able to prove that any other clinical sign/symptom or POCT CPR adds useful information to the UTI diagnosis. We confirmed the findings of earlier research that urine dipstick tests are useful in ruling out UTIs and identified a potential overuse of antimicrobials in our NH population.

Keywords: Aged; Long-term care; Point-of-care testing; Urinary tract infections.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Signs/symptoms triggering suspicion of a UTI in Belgian nursing home residents. UTI Urinary tract infection
Fig. 2
Fig. 2
Performance of signs/symptoms, urine dipstick test and C-reactive protein in diagnosing confirmed UTIsa. aConfirmed UTIs: Urinary tract infections corresponding to the definition of a UTI as described in an article of Stone MD et al., i.e. presence of enough urinary signs and/or symptoms and a positive urine culture [24], CRP C-reactive protein, Sens Sensitivity, Spec Specificity, LR + Positive likelihood ratio, LR- Negative likelihood ratio, CI Confidence interval, Sens, Spec, and their 95% CIs are expressed as percentages
See this image and copyright information in PMC

Comment in

  • Geriatrics.
    Griebling TL. Griebling TL. J Urol. 2022 Oct;208(4):909-911. doi: 10.1097/JU.0000000000002876. Epub 2022 Jul 28. J Urol. 2022. PMID: 35900810 No abstract available.

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