title: High Diagnostic Accuracy of Nitrite Test Paired with Urine Sediment can Reduce Unnecessary Antibiotic Therapy.
abstract: BACKGROUND
  Urinary tract infections (UTIs) are common bacterial infections dominated by lower UTI in women (LUTIW). Symptoms only are insufficient for diagnosis and accordingly, near patient diagnostic tests confidently confirming significant bacteriuria are desirable. The nitrite test (NIT) has low sensitivity, while bacterial and leukocyte counts disjunctively paired in urine sediment microscopy (SED) have high sensitivity. Similar symptomatic cure rates are found post antibiotic vs. placebo therapy in patients with negative cultures. Consequently, prescription on symptoms only implies unnecessary antibiotic therapy.
  
  
  OBJECTIVE
  to evaluate the diagnostic outcomes of NIT, SED and NIT disjunctively paired with SED (NIT+SED) vs. urine culture, with special focus on bladder incubation time (BIT), and to assess if NIT+SED can reduce unnecessary antibiotic therapy.
  
  
  METHODS
  A diagnostic, primary care, multicentre study including 1070 women with symptoms suggestive of lower UTI.
  
  
  RESULTS
  Significant bacteriuria was found in 77%. The BIT highly influenced the diagnostic outcomes and the optimal duration was ≥4h with sensitivity of 66, 90 and 95% for NIT, SED and NIT+SED, respectively. SED performed only in NIT negative specimens could reduce unnecessary antibiotics by 10% vs. prescription on symptoms only. The number needed to test with SED to reduce one unnecessary antibiotic course was five patients at BIT ≥4h and six patients at ≤3h or overall.
  
  
  CONCLUSIONS
  The BIT highly influences the diagnostic outcomes with the highest accuracy of NIT+SED. Diagnosis of LUTIW with NIT+SED can reduce unnecessary antibiotic therapy and subsequently decrease antimicrobial resistance.
  
  
  BACKGROUND
  The Swedish Medical Product Agency 1995 03 01:151:01783/94.
authors.affiliation: Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden.
authors.forename: Sven A
authors.initials: SA
authors.lastname: Ferry
authors.affiliation: Department of Medical Microbiology and Immunology, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Stig
authors.initials: S
authors.lastname: E Holm
authors.affiliation: Department of Education, Umea University, Umea, Sweden.
authors.forename: B Magnus
authors.initials: BM
authors.lastname: Ferry
authors.affiliation: Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden.
authors.forename: Tor J
authors.initials: TJ
authors.lastname: Monsen
keywords: Antibiotic resistance; bacteria; bladder incubation time; diagnosis; dipstick test; leukocytes; primary care; urinary tract infection