Diagnosis of Urinary Tract Infections by Urine Flow Cytometry: Adjusted Cut-Off Values in Different Clinical Presentations.

Schuh, Sabine K.; Seidenberg, Ruth; Arampatzis, Spyridon; Leichtle, Alexander B.; Hautz, Wolf E.; Exadaktylos, Aristomenis K.; Schechter, Clyde B; Müller, Martin (2019). Diagnosis of Urinary Tract Infections by Urine Flow Cytometry: Adjusted Cut-Off Values in Different Clinical Presentations. Disease markers, 2019(5853486), p. 5853486. Hindawi 10.1155/2019/5853486

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Background Bacterium and leucocyte counts in urine can be measured by urine flow cytometry (UFC). They are used to predict significant bacterial growth in urine culture and to diagnose infections of the urinary tract. However, little information is available on appropriate UFC cut-off values for bacterium and leucocyte counts in specific clinical presentations. Objective To develop, validate, and evaluate adapted cut-off values that result in a high negative predictive value for significant bacterial growth in urine culture in common clinical presentation subgroups. Methods This is a single center, retrospective, observational study with data from patients of the emergency department of Bern University Hospital, Switzerland, with suspected infections of the urinary tract. The patients presented with different symptoms, and urine culture and urine flow cytometry were performed. For different clinical presentations, the patients were grouped by (i) age (>65 years), (ii) sex, (iii) clinical symptoms (e.g., fever or dysuria), and (iv) comorbidities such as diabetes and immunosuppression. For each group, cut-off values were developed, validated, and analyzed using different strategies, i.e., linear discriminant analysis (LDA) and Youden's index, and were compared with known cut-offs and cut-offs optimized for sensitivity. Results 613 patients were included in the study. Significant bacterial growth in urine culture depended on clinical presentation and ranged from 32.3% in male patients to 61.5% in patients with urinary frequency. In all clinical presentations, the predictive accuracy of UFC leucocyte and UFC bacterium counts was good for significant bacterial growth in urine culture (AUC ≥ 0.88). The adapted LDA95 equations did not exhibit consistently high sensitivity. However, the in-house cut-offs (test positive if UFC leucocytes > 17/μL or UFC bacteria > 125/μL) were highly sensitive (>90%). In female, younger, and dysuric patients, even higher cut-offs for UFC leucocytes (169/μL, 169/μL, and 205/μL) exhibited high sensitivity. Specificity was insufficient (<0.9) for all tested cut-offs. Conclusions For various clinical presentations, significant bacterial growth in urine culture can be excluded if flow cytometry measurements give a bacterial count of ≤125/μL or a leucocyte count of ≤17/μL. In female patients, dysuric patients, and patients younger than ≤65 years, the leucocyte cut-off can be increased to 170/μL.

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 Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center

UniBE Contributor:

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

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1875-8630

Publisher:

Hindawi

Language:

English

Submitter:

Romana Saredi

Date Deposited:

16 Dec 2019 09:00

Last Modified:

22 Dec 2019 02:46

Publisher DOI:

10.1155/2019/5853486

PubMed ID:

30944667

BORIS DOI:

10.7892/boris.136539

URI:

https://boris.unibe.ch/id/eprint/136539

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