Can urine dipstick test be an alternative to detect urinary tract infection in limited resource setting? - A validity study from Bangalore, India

Background: Diagnosis of urinary tract infection (UTI) can be challenging as symptoms are nonspecific. The gold standard for the diagnosis of urine culture is not easily available in resource constrained settings. Hence, the need for affordable point of care diagnostic test could be an inexpensive alternative for urine culture or microscopy. The objective of the study was to validate the urine dipstick test to detect UTI in a resource constrained primary care setting. Methods: A diagnostic accuracy study was conducted in a health center in an urban slum by Bangalore Baptist Hospital. We included 136 patients suspected to have UTI. Patients were asked to give urine samples for urine dipstick analysis, urine microscopy, and urine culture and validity of the dipstick was analyzed. Results: A total of 136 patients fulfilling the inclusion criteria were recruited. Nitrite had higher specificity than leukocyte esterase (95% vs. 73%). Positive predictive value for nitrite and leukocyte was 84% and 51%, respectively. A combination of fever, dysuria along with lower abdominal pain had higher specificity (92%). Most common organism that was isolated was E. coli (56%) followed by S. aureus (13%). E. coli was susceptible to nitrofurontoin. Conclusion: Urine dipstick could be used as a simple diagnostic test in a limited resource setting for a rapid diagnosis and initiation of empirical antibiotic therapy. Urine dipstick for nitrite has a good specificity.