Lack of clinical utility of urine gram stain for suspected urinary tract infection in pediatric patients

Joseph B. Cantey, Claudia Gaviria-Agudelo, Erin McElvania TeKippe, Christopher D. Doern

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Urinary tract infection (UTI) is one of the most common infections in children. Urine culture remains the gold standard for diagnosis, but the utility of urine Gram stain relative to urinalysis (UA) is unclear. We reviewed 312 pediatric patients with suspected UTI who had urine culture, UA, and urine Gram stain performed from a single urine specimen. UA was considered positive if ≥10 leukocytes per oil immersion field were seen or if either nitrates or leukocyte esterase testing was positive. Urine Gram stain was considered positive if any organisms were seen. Sensitivity, specificity, and positive and negative predictive values were calculated using urine culture as the gold standard. Thirty-seven (12%) patients had a culture-proven UTI. Compared to urine Gram stain, UA had equal sensitivity (97.3% versus 97.5%) and higher specificity (85% versus 74%). Empirical therapy was prescribed before the Gram stain result was known in 40 (49%) patients and after in 42 (51%) patients. The antibiotics chosen did not differ between the two groups (P = 0.81), nor did they differ for patients with Gram-negative rods on urine Gram stain compared to those with Gram-positive cocci (P = 0.67). From these data, we conclude that UA has excellent negative predictive value that is not enhanced by urine Gram stain and that antibiotic selection did not vary based on the urine Gram stain result. In conclusion, the clinical utility of urine Gram stain does not warrant the time or cost it requires.

Original languageEnglish (US)
Pages (from-to)1282-1285
Number of pages4
JournalJournal of Clinical Microbiology
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2015

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Urinary Tract Infections
Urine
Pediatrics
Urinalysis
Gram's stain
Anti-Bacterial Agents
Oil and Gas Fields
Gram-Positive Cocci
Immersion
Nitrates
Leukocytes
Costs and Cost Analysis
Sensitivity and Specificity

ASJC Scopus subject areas

  • Microbiology (medical)

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Lack of clinical utility of urine gram stain for suspected urinary tract infection in pediatric patients. / Cantey, Joseph B.; Gaviria-Agudelo, Claudia; TeKippe, Erin McElvania; Doern, Christopher D.

In: Journal of Clinical Microbiology, Vol. 53, No. 4, 01.04.2015, p. 1282-1285.

Research output: Contribution to journalArticle

Cantey, Joseph B. ; Gaviria-Agudelo, Claudia ; TeKippe, Erin McElvania ; Doern, Christopher D. / Lack of clinical utility of urine gram stain for suspected urinary tract infection in pediatric patients. In: Journal of Clinical Microbiology. 2015 ; Vol. 53, No. 4. pp. 1282-1285.
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