Boer, F.J. de (2014) Flowcytometrische detectie van urineweginfecties bij patiënten met koorts. thesis, Medicine.
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Abstract
Background: Fast and reliable urinalysis is important in febrile patients in the emergency department. Current urine tests are moderately reliable and fast, or reliable but time consuming. Accurate diagnosis before starting with antibiotics is important to minimize resistance. The urine culture is worldwide accepted as the gold standard, but a time consuming and costly test, a large proportion of samples are negative. Flow cytometric counting of bacteria and leukocytes might be a good alternative. The aim of this study is to select an optimal strategy for urinalysis in febrile patients in the emergency department. Methods: Urine was obtained from 140 consecutive febrile patients in the emergency department. Dipstick, urine sediment, Gram stain and urine cultures were performed according to protocol. Flow cytometric analysis for bacteria and leukocytes was performed with the Accuri C6 flow cytometer. Diagnostic values were determined by using urine culture as the gold standard, a culture was considered positive with ≥105 CFU/mL. Results: 1 in 3 febrile patients had a complicated urinary tract infection, 25% of the patients had a positive urine culture. The highest diagnostic accuracy for urinalysis was obtained with Gram stain and flow cytometric analysis, with AUCs of 0.953 and 0.957. The cutoff value for bacteria was 1.86 x 106 bacteria/mL, this resulted in a sensitivity of 94.7 % and a specificity of 88.2%. Pre-screening with the Accuri C6 would have resulted in a reduction of bacterial cultures by 56.4%. A cutoff value of 37 leukocytes/μL resulted in a sensitivity of 84.2% and a specificity of 67.6%. Conclusions: The Accuri C6 and Gram stain both have a high diagnostic value in urinalysis in febrile patients, but the Accuri C6 is much faster. Pre-screening urine samples with the Accuri C6 results in a reduction of urine cultures, workload and costs. Bacteriuria seems to be a better predictor for urinary tract infection than leukocyturia.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Groeneveld, dr. P.H.P. and Isala Klinieken, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/701 |
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