The development and validation of different decision-making tools to predict urine culture growth out of urine flow cytometry parameter

Müller, Martin; Seidenberg, Ruth; Schuh, Sabine K.; Exadaktylos, Aristomenis; Schechter, Clyde B.; Leichtle, Alexander B.; Hautz, Wolf (2018). The development and validation of different decision-making tools to predict urine culture growth out of urine flow cytometry parameter. PLoS ONE, 13(2), e0193255. Public Library of Science 10.1371/journal.pone.0193255

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Objective Patients presenting with suspected urinary tract infection are common in every day emergency practice. Urine flow cytometry has replaced microscopic urine evaluation in many emergency departments, but interpretation of the results remains challenging. The aim of this study was to develop and validate tools that predict urine culture growth out of urine flow cytometry parameter. Methods This retrospective study included all adult patients that presented in a large emergency department between January and July 2017 with a suspected urinary tract infection and had a urine flow cytometry as well as a urine culture obtained. The objective was to identify urine flow cytometry parameters that reliably predict urine culture growth and mixed flora growth. The data set was split into a training (70%) and a validation set (30%) and different decision-making approaches were developed and validated. Results Relevant urine culture growth (respectively mixed flora growth) was found in 40.2% (7.2% respectively) of the 613 patients included. The number of leukocytes and bacteria in flow cytometry were highly associated with urine culture growth, but mixed flora growth could not be sufficiently predicted from the urine flow cytometry parameters. A decision tree, predictive value figures, a nomogram, and a cut-off table to predict urine culture growth from bacteria and leukocyte count were developed, validated and compared. Conclusions Urine flow cytometry parameters are insufficient to predict mixed flora growth. However, the prediction of urine culture growth based on bacteria and leukocyte count is highly accurate and the developed tools should be used as part of the decision-making process of ordering a urine culture or starting an antibiotic therapy if a urogenital infection is suspected.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Müller, Martin; Seidenberg, Ruth; Schuh, Sabine; Exadaktylos, Aristomenis; Leichtle, Alexander Benedikt and Hautz, Wolf

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Romana Saredi

Date Deposited:

06 Feb 2019 09:24

Last Modified:

10 Feb 2019 02:41

Publisher DOI:

10.1371/journal.pone.0193255

PubMed ID:

29474463

BORIS DOI:

10.7892/boris.125570

URI:

https://boris.unibe.ch/id/eprint/125570

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