The diagnostic accuracy of the point-of-care urine dipstick test in detecting urinary tract infection among symptomatic patients in Nairobi County, Kenya.

ObjectivesA cross-sectional study was conducted to evaluate the diagnostic performance of clinical symptoms and dipstick urinalysis, both individually and in combination, in predicting urine culture positivity. MethodsConsenting patients with symptoms suggestive of UTI provided midstream urine samples. Dipstick was used to identify Nitrites (NIT) and leucocyte esterase (LE). Urine was cultured on Cystine Lactose Electrolyte Deficient agar (CLED) and incubated at 370C for 24 hours. Pure bacterial colony counts of [&ge;]104 cfu/mL were classified as "positive" for UTI. ResultsA total of 552 participants were enrolled. Frequency, smelling cloudy urine, haematuria, and fever were associated with positive urine culture (P <0.05). The symptoms were predictive of UTI when fever was included, and better when a combination of urinary symptoms plus fever were present. Urinary dipstick sensitivity was poor overall. LE+ or NIT+ dipstick result achieved sensitivity of 67%. Combined NIT+ and LE+ had the highest specificity (99%) and a positive predictive value of 91%. Combining symptoms with dipstick improved the predictive accuracy of culture positivity. ConclusionAn algorithm-based combination of symptoms and dipstick testing in outpatient settings where culture is rarely performed could improve UTI diagnosis and promote more appropriate antibiotic use.