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LETTER TO EDITOR
J Res Med Sci 2017,  22:77

Performance of urinalysis tests in screening for significant bacteriuria among human immunodeficiency virus-infected subjects in South India


1 Infectious Diseases Laboratory, Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India; Laboratory.based Department, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
2 Infectious Diseases Laboratory, Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India
3 Infectious Diseases Laboratory, Y.R. Gaitonde Centre for AIDS Research and Education; Medical Centre, Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamilnadu, India; Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA

Date of Web Publication21-Jun-2017

Correspondence Address:
Pachamuthu Balakrishnan
Infectious Diseases Laboratory, Y.R. Gaitonde Centre for AIDS Research and Education, 2nd Floor, Admin Building, VHS Hospital Campus, Rajiv Gandhi Salai, Taramani, Chennai - 600 113, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrms.JRMS_567_16

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How to cite this article:
Vignesh R, Swathirajan CR, Solomon SS, Solomon S, Balakrishnan P. Performance of urinalysis tests in screening for significant bacteriuria among human immunodeficiency virus-infected subjects in South India. J Res Med Sci 2017;22:77

How to cite this URL:
Vignesh R, Swathirajan CR, Solomon SS, Solomon S, Balakrishnan P. Performance of urinalysis tests in screening for significant bacteriuria among human immunodeficiency virus-infected subjects in South India. J Res Med Sci [serial online] 2017 [cited 2020 Oct 26];22:77. Available from: https://www.jmsjournal.net/text.asp?2017/22/1/77/208741

Sir,

While opportunistic infections in human immunodeficiency virus (HIV) infected individuals are extensively studied, very limited data are available on urinary tract infections (UTIs) in HIV patients.[1] We evaluated the usefulness of rapid urine dipstick tests and microscopy for detecting bacteriuria against urine culture in HIV setting and investigated if these rapid screening tests could replace urine culture, thereby, reducing the costs and time for laboratory diagnosis.

A total of 550 HIV-infected individuals presenting with symptoms of UTI from January 2011 to December 2014, were included. Since the data were retrospectively analyzed from laboratory records, we did not seek any IRB approval. Moreover, this study does not link any patient identification details in the analysis or elsewhere. Each subject had submitted a fresh, random mid-stream urine specimen. A dipstick-based urinalysis (Multiple ® Reagent Strips for Urinalysis, Siemens, NY, USA) was immediately performed to detect leukocyte esterase (LE) and nitrite (NIT). Microscopy for pyuria was also performed on centrifuged urine specimens. Semiquantitative urine culture was performed, and the significant bacterial isolates were identified by standard procedures.[2] Urinalysis results were correlated with results of urine cultures and performance characteristics of urinalysis tests were evaluated.

Of the study population, 57.6% were females with mean age of 30.3 years (range, 4–66) and the rest were males with mean age of 38.6 years (range, 1–79). Most infections were due to  Escherichia More Details coli (10.7%), followed by other members of family Enterobacteriaceae, Staphylococcus aureus and Pseudomonas aeruginosa. [Table 1] outlines the performance of the urinalysis tests for detection of significant bacteriuria. A positive urinalysis result (combining the LE, NIT and excluding microscopy) had a sensitivity of 57.4% and a specificity of 99.7%. On further analysis by including only the Gram-positive uropathogens, the LE's sensitivity and specificity dropped to about 72.2% and 68.5%, respectively. However, sensitivity and specificity of NIT including only the Enterobacteriaceae members modestly raised to 36.7% and 99.5%, respectively.
Table 1: Performance of the leukocyte esterase, nitrite and microscopy urinalysis tests in screening for significant bacteriuria among human immunodeficiency virus infected subjects

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The results of the present study expand the previous findings in other non-HIV study populations that the performance of the rapid screening dipstick urinalysis tests as compared with the culture results is relatively poor.[3],[4],[5] Although these rapid tests allow HIV-infected individuals to be screened and treated in the same visit, the decreased sensitivity of dipstick tests in detecting significant bacteriuria limits the diagnostic utility in HIV clinical care settings. Albeit being 3-fold more expensive and requiring multiple visits to clinic, the urine culture results with antibiogram ensure targeted therapy thereby eliminating the risks of indiscriminate antibiotics usage. Hence, the results of rapid dipstick urinalysis tests might not be sufficient enough to replace the conventional urine culture method, and the clinical decision is to be made only based on the culture and sensitivity results among the HIV-infected patients.

Acknowledgments

The authors are grateful to the study participants and the staff at YRG CARE for the support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Vignesh R, Shankar EM, Murugavel KG, Kumarasamy N, Sekar R, Irene P, et al. Urinary infections due to multi-drug-resistant Escherichia coli among persons with HIV disease at a tertiary AIDS care centre in South India. Nephron Clin Pract 2008;110:c55-7.  Back to cited text no. 1
    
2.
Myer's and Koshi's Manual of Diagnostic Procedures in Medical Microbiology and Immunology/Serology. Faculty of Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India. Kennedy Nagar, Pondicherry, India: All India Press; 2001. p. 31-7.  Back to cited text no. 2
    
3.
Nys S, van Merode T, Bartelds AI, Stobberingh EE. Urinary tract infections in general practice patients: Diagnostic tests versus bacteriological culture. J Antimicrob Chemother 2006;57:955-8.  Back to cited text no. 3
    
4.
Taneja N, Chatterjee SS, Singh M, Sivapriya S, Sharma M, Sharma SK. Validity of quantitative unspun urine microscopy, dipstick test leucocyte esterase and nitrite tests in rapidly diagnosing urinary tract infections. J Assoc Physicians India 2010;58:485-7.  Back to cited text no. 4
    
5.
Mambatta AK, Jayarajan J, Rashme VL, Harini S, Menon S, Kuppusamy J. Reliability of dipstick assay in predicting urinary tract infection. J Family Med Prim Care 2015;4:265-8.  Back to cited text no. 5
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