The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border.

Journal article

Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship.One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >10(5)  CFU/ml.In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells <5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive.One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy.

Authors: Chalmers, L; Cross, J; Chu, C; Phyo, A; Trip, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Tropical Medicine and International Health : TM and IH
• Volume: 20
• Issue: 10
• Pages: 1281-1289
• Publication date: 2015-10-01
• DOI: 10.1111/tmi.12541
• EISSN: 1365-3156
• ISSN: 1360-2276
• Language: English
• Keywords: urinary tract infection; Adolescent; Anti-Bacterial Agents; tests au point des soins; Aged; Adult; extended-spectrum β-lactamase; pruebas de diagnóstico en el punto de atención; Escherichia coli; infección del tracto urinario; Sensitivity and Specificity; Urinary Tract Infections; infection des voies urinaires; Thailand; Middle Aged; point-of-care tests; betalactamasas de amplio espectro; BLSE; antibiotic resistance; Male; resistencia a antibióticos; Female; Humans; beta-Lactamases; Retrospective Studies; résistance aux antibiotiques; Reproducibility of Results; Outpatients; Young Adult