Urine specimen collection from incontinent female nursing home residents.
OBJECTIVE
To determine if a clean catch technique can accurately diagnose bacteriuria among incontinent female nursing home residents.


METHODS
Cultures and dipstick screening test results from paired urine specimens, one collected by a clean catch technique and the other collected by sterile in-and-out catheterization, were compared.


METHODS
A total of 101 incontinent female nursing home residents who were being assessed for participation in a larger clinical intervention trial for incontinence.


METHODS
Each urine was tested by a dipstick method for leukocyte esterase and nitrite and sent to a bioclinical laboratory for quantitative culture.


RESULTS
Positive and negative culture results matched in 92 of the 101 paired specimens. Using the catheter specimen as a gold standard, the clean catch had a sensitivity of 90%, specificity of 92%, positive predictive value of 81%, and a negative predictive value of 95%. In a population with symptoms suggestive of infection, among whom the prevalence of bacteriuria would likely be higher than in the asymptomatic residents we studied (e.g., 60% vs 30%), the positive predictive value would increase to 95%, but the negative predictive value would decrease to 86%. The concordance of the results of the urine screening tests was not as good, except for the detection of a positive leukocyte esterase test and a negative nitrite test.


CONCLUSIONS
Incontinent female nursing home residents do not necessarily have to be catheterized in order to obtain an accurate quantitative urine culture. Our results using a careful clean catch technique are comparable to those previously reported using urine obtained from a urine-soiled diaper as well as those using a condom catheter technique in men.
Ouslander
J G
JG
UCLA Borun Center for Gerontological Research.
Schapira
M
M
Schnelle
J F
JF
D000368:Aged; D000369:Aged, 80 and over; D001437:Bacteriuria / Q000150:complications / Q000201:enzymology / Q000652:urine*; D002265:Carboxylic Ester Hydrolases / Q000652:urine; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D009573:Nitrites / Q000652:urine; D009735:Nursing Homes; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D014546:Urinary Catheterization / Q000379:methods*; D014549:Urinary Incontinence / Q000150:complications* / Q000652:urine
D009573:Nitrites; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases