title: Diagnostic accuracy of urinary dipstick to exclude catheter-associated urinary tract infection in ICU patients: a reappraisal.
abstract: OBJECTIVE
  We wanted to assess the diagnostic accuracy of urinary dipstick testing in excluding catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients with fever or hypothermia.
  
  
  METHODS
  This was a prospective observational cohort study in a medical-surgical ICU. Patients with new-onset fever >38.3 °C or hypothermia <36 °C at least 48 h after urinary catheter insertion were included over a 2-year period. At each episode, a urinary dipstick test and a urine culture were performed as the criterion standard. Extensive microbiological investigations for extra-urinary infections were performed also. The performances of various urinary dipstick result combinations in ruling out CAUTI were compared based on the likelihood ratios (LR+ and LR-).
  
  
  RESULTS
  Symptomatic CAUTI was diagnosed in 31 (24.4 %) of the 127 included patients (195 episodes of fever or hypothermia). LR+ was best for combined leukocyte esterase-positive and nitrite-positive dipstick results (overall population: 14.91; 95 % confidence interval [95 % CI], 5.53-40.19; patients without urinary symptoms: 15.63; 95 % CI, 5.76-42.39). LR- was best for either leukocyte esterase-positive or nitrite-positive dipstick results (overall population: 0.41; 95 % CI, 0.57-0.65; patients without urinary symptoms, 0.36; 95 % CI, 0.21-0.60).
  
  
  CONCLUSIONS
  Urinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia.
authors.affiliation: Intensive Care Unit, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay cedex (78), France.
authors.forename: T
authors.initials: T
authors.lastname: Coman
authors.forename: G
authors.initials: G
authors.lastname: Troché
authors.forename: O
authors.initials: O
authors.lastname: Semoun
authors.forename: B
authors.initials: B
authors.lastname: Pangon
authors.forename: F
authors.initials: F
authors.lastname: Mignon
authors.forename: G
authors.initials: G
authors.lastname: Jacq
authors.forename: S
authors.initials: S
authors.lastname: Merceron
authors.forename: N
authors.initials: N
authors.lastname: Abbosh
authors.forename: V
authors.initials: V
authors.lastname: Laurent
authors.forename: P
authors.initials: P
authors.lastname: Guezennec
authors.forename: M
authors.initials: M
authors.lastname: Henry-Lagarrigue
authors.forename: L
authors.initials: L
authors.lastname: Revault-d'Allonnes
authors.forename: H
authors.initials: H
authors.lastname: Ben-Mokhtar
authors.forename: J
authors.initials: J
authors.lastname: Audibert
authors.forename: F
authors.initials: F
authors.lastname: Bruneel
authors.forename: M
authors.initials: M
authors.lastname: Resche-Rigon
authors.forename: J-P
authors.initials: JP
authors.lastname: Bedos
authors.forename: S
authors.initials: S
authors.lastname: Legriel
mesh_terms: D000328:Adult; D002265:Carboxylic Ester Hydrolases / Q000032:analysis; D055499:Catheter-Related Infections / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D007035:Hypothermia / Q000209:etiology*; D007362:Intensive Care Units; D008297:Male; D008828:Microbiological Techniques; D008875:Middle Aged; D009573:Nitrites / Q000032:analysis; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis*; D014556:Urine / Q000737:chemistry* / Q000382:microbiology
chemical_list: D009573:Nitrites; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases