Diagnostic Value of Different Urine Tests for Urinary Tract Infection

A Systematic Review and Meta-Analysis

Rong Xie; Xinli Li; Guangquan Li; Rong Fu

Disclosures

Transl Androl Urol. 2022;11(3):325-335. 

In This Article

Abstract and Introduction

Abstract

Background: There are differences in specificity and sensitivity of different routine urine tests for urinary tract infection, so meta-analysis was used to compare the diagnostic value of various urine analysis and detection methods in urinary tract infection, including bacterial culture, urine sediment microscopy, automated urinalysis, and routine urine dry chemical methods.

Methods: The PubMed, Embase, Cochrane Library, SpringerLink, CNKI, and Wanfang databases were searched from inception to December 2021. Two system assessors independently screened the literature according to the inclusion and exclusion criteria. RevMan version 5.3 (the Cochrane Collaboration) and Meta-DiSc were used to calculate the combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic ratio (DOR) of the diagnostic tests and draw summary receiver operating characteristic (SROC) curves.

Results: A total of 14 documents were included according to the inclusion and exclusion criteria. There was a significant statistical difference between the urine sediment microscopy group and the urine normalization group in urine leucocyte detection (OR =2.15, 95% CI: 1.29–3.56, P=0.003, I2=19%, Z=2.95), urine erythrocyte test (OR =1.87, 95% CI: 1.13–3.09, P=0.01, I2=0%, Z=2.45), quantitative determination of urinary protein composition (OR =2.32, 95% CI: 1.27–4.23, P=0.006, I2=30%, Z=2.73), and determination of urinary enzymes (OR =1.67, 95% CI: 1.03–2.72, P=0.04, I2=0%, Z=2.07).

Discussion: When examining red and white blood cells in urinary tract infection diagnosis, urine dry chemistry is superior to automated urinalysis in terms of area under the curve (AUC), Sen, Spe, etc. When examining urine bacteria, urine dry chemistry can be recommended for urine bacteria screening, with bacterial culture required for confirmation.

Introduction

Urinary tract infection is a common nosocomial infection. Many factors contribute to the development of urinary tract infection, such as lengthy indwelling catheter time or untimely treatment of the infection. Diagnosis of urinary tract infection cannot rely on clinical symptoms alone and should be combined with biochemical test results to effectively determine the infection site and allow for targeted treatment in order to promote patient recovery.[1] If urinary tract infection is not treated effectively, the infection will become chronic, which can have a serious impact on a patient's health and quality of life.[2] Routine urine dry chemical testing is favored by the majority of doctors and is often used in clinical practice due to its rapid and efficient results.[3–5]

If urinary tract infection occurs more than 3 times in 1 year, it can be characterized as a recurrent urinary tract infection. Recurrent urinary tract infection is a persistent disease of the urinary system that seriously affects quality of life. Currently, clinical treatment of recurrent urinary tract infection is difficult, and there is an urgent need to improve the level of diagnosis and treatment.[6] Recurrent urinary tract infection requires timely and standardized treatment to actively improve the cure rate.[7] The pathogens of urinary tract infection are bacterial, but the main pathogenic bacteria have yet to be defined. Antimicrobial drugs are the front-line treatment for urinary tract infection. However, as many patients are prescribed broad-spectrum antibiotics, differing degrees of drug resistance have developed in the population, leading to a significant reduction in drug effectiveness. Therefore, it is necessary to actively analyze the distribution of pathogenic bacteria in patients with recurrent urinary tract infection and explore the sensitivity of pathogenic bacteria to commonly used antimicrobial drugs so as to develop more reliable treatments.[8]

Existing tests for urinary tract infections: (I) Urinary routine is a very important basic examination in clinical practice, especially in the diagnosis of urinary tract infection, which has the advantages of simple operation, fast price and low price, and can be accepted by the majority of patients, and this diagnosis method has high diagnostic accuracy. Urine routine has a high frequency of application in clinical practice, which can effectively diagnose a variety of diseases. (II) Urography: Lead to urinary tract infection pathogens types varied, if it is n/med tuberculosis bacterium infection, then completes the urinary tract imaging examination is very important, and want to make the diagnosis on the basis of more powerful, so should also be ultrasound examination, the urinary system can discover whether urinary tract obstruction or whether any stones, better able to analyze the type of urinary tract infection. (III) CT: This examination can find the lesion of urinary tract infection very well. This examination method can better understand the whole process of the lesion in detail, which is of high value for the diagnosis of urinary tract infection.

There are many pathogenic types of recurrent urinary tract infection, including both Gram-negative and relatively low Gram-positive bacteria. Gram-negative bacteria consist of Escherichia coli, Pseudomonas aeruginosa, with each strain accounting for about 20% to 60% of the total Gram-negative bacteria. Urinary tract infection is an inflammatory condition caused by pathogens invading the urinary tract mucosa and nearby tissues.[9] Generally, urinary tract infections are divided into upper urinary tract infections (pyelonephritis) and lower urinary tract infections (cystitis, urethritis), most of which occur in women. When diagnosing urinary tract infection, most practitioners will use a urine dipstick test. However, clinical evidence suggests that this method is not sufficient to complete the diagnosis. Therefore, this paper will explore the different tests used in the diagnosis of urinary tract infection.[10]

Lesion changes in the endocrine, circulatory, urinary, and digestive systems are often reflected in the changes of urine biochemical indicators. Current urine analysis methods include visual measurement, physics, chemistry, microscopy, and automatic analysis using urine analyzer instruments. The detection of bacteria, leukocytes, and red blood cells in urinary tract infection can be assessed by sediment microscopy, automated urinalysis, bacterial culture, and routine urine dry chemical methods. The selection of an appropriate urine detection method can provide better evidence for the diagnosis of the disease. Different studies believe that the clinical diagnostic value of different urinary tract tests is different, but some studies have found that the sensitivity and specificity of different urinary tract tests are not different, and there are certain controversies. In this study, meta-analysis was used to compare the effectiveness of multiple urine analysis detection methods. We present the following article in accordance with the PRISMA-DTA reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-22-65/rc).

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