1028 How reliable is ward urine microscopy as compared to urine dipstick in the management of urinary tract infections in children?

Aims To compare utility of ward urine microscopy to urine dipstick and laboratory-based urine microscopy and culture in the diagnosis and management of urinary tract infection. Methods All children diagnosed with UTI between September 2019 and February 2020 were studied. Clinical symptoms, urine dipstick (Leucocyte Esterase [LE] and nitrite), ward microscopy (WM) and laboratory microscopy/culture (LMC) results were recorded, and data was analysed using Microsoft excel. Urine culture was used as gold standard for diagnosis of UTI. Results Fifty-nine children (M 48: F 11) were diagnosed with UTI. 5 children were < 3 months, 24 children between 3 months to 3 years and 30 children > 3 years. Clinical symptoms suggestive of UTI were present in 57/59 children. 54 urine samples were available. Urine dipstick showed positive result for 42/54 samples (LE and Nitrite positive 19, Nitrite only 3, LE only 23), negative for 6/54 and no results for 3/54. Laboratory Culture confirmed UTI in 25/54, No growth in 26/54 and no result available in 3/54. Urine dipstick and Culture results were available in 48 samples. Of the 48, 24 patients had positive Urine dipstick and culture, 18 had positive Urine dipstick but negative Urine culture and 6 had both negative Urine dipstick and Urine culture. Overall, 30 Urine dipstick results (62.5%) were concordant with Urine culture results. Ward microscopy (WM) was done in only 14/54 samples. Urine culture result was not available for 1 sample and hence only 13 samples were used for analysis. Only 6 of these 13 cases (46%) where bedside microscopy (BM) was done had results correlating with LMC. Conclusion Our study shows that Urine dipstick is more reliable (62.5% vs 46%) than bedside Urine microscopy in the diagnosis of UTI. Overall Urine dipstick results were in keeping with Urine culture results in 62.5% of cases. There was no significant added value in doing ward microscopy.