The utility of urinary dipstick in the diagnosis of urinary tract infection in children

Background: Urinary tract infection (UTI) is frequent in children and may have significant adverse effects, especially for young children. Objective: The objective was to assess the sensitivity and specificity of pyuria, leukocyte esterase, and nitrite test in the diagnosis of UTI and whether they can be used as an alternative to the conventional culture, which is expensive and needs more time for the result to be obtained. Methods: This is a cross-sectional study in which 143 patients were prospectively studied in Kerbela teaching hospital for children, who were suspected to have UTI and did not receive antibiotics for at least a week. Urine samples were collected using urine catheter for children who are not toilet trained and midstream urine for older children. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured for nitrite, leukocyte esterase, and pyuria. Results: There was a highly significant association between the positive results of urine dipstick (nitrite test and leukocyte esterase test) and microscopic (examination for pyuria) and the positive results of urine culture (P < 0.001). There were no significant differences between dipstick (nitrate test and leukocyte esterase) and pyuria at sensitivity, specificity, PPVs, and NPVs (P = 0.514, 0.706, 0.232, and 0.414, respectively). Conclusions: The dipstick tests had no significantly different results compared with examination for pyuria and urine culture in the detection of UTIs. Escherichia coli is the most common isolated organism, and it is sensitive mainly to third-generation cephalosporin and amikacin.