Nitrite and leukocyte dipstick testing for urinary tract infection in individuals with spinal cord injury.
OBJECTIVE
To determine sensitivity, specificity, and positive and negative predictive values of nitrite (NIT) and leukocyte esterase (LE) testing in relation to laboratory evidence of significant bacteriuria and urinary tract infection (UTI) in persons with spinal cord injury (SCI).


METHODS
Monthly urine cultures were compared with results of dipstick testing.


METHODS
Community based.


METHODS
Fifty-six people with SCI were evaluated on a monthly basis with dipstick testing for NIT and LE as well as urine cultures. Participants reported whether they believed that they had a UTI and, if so, whether they were treated for the UTI and what symptoms they had experienced.


RESULTS
The sensitivity rate for the most comprehensive criteria--defined as positive NIT test, a positive LE positive, or both a positive NIT test and positive LE test--was 0.64 and the specificity rate was only 0.52. No single type of bacteria was found to occur in more than 30% of the urine samples.


CONCLUSIONS
Reliance on dipstick testing for NIT and LE in individuals with SCI can lead to high rates of overtreatment for UTI, given the fact that regular catheterization is associated with significant bacteriuria. Individuals with SCI should be evaluated with urine culture to ensure proper treatment.
Hoffman
Jeanne M
JM
University of Washington, Department of Rehabilitation Medicine, Seattle, Washington 98195-6490, USA. jeanneh@u.washington.edu
Wadhwani
Rohini
R
Kelly
Eve
E
Dixit
Bonnie
B
Cardenas
Diana D
DD
D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D002265:Carboxylic Ester Hydrolases / Q000652:urine*; D006801:Humans; D009573:Nitrites / Q000652:urine*; D011237:Predictive Value of Tests; D011934:Reagent Strips; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000150:complications* / Q000473:pathology / Q000652:urine; D016482:Urinalysis / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000209:etiology*; D014556:Urine / Q000382:microbiology
D009573:Nitrites; D011934:Reagent Strips; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases