Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals
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Introduction. Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis.
Research gap. In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials.
Aim. The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals.
Methods. A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard.
Results. The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test’s sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %).
Conclusion. Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test’s sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.
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This is a study that would be of interest to the field and community. Thank you for the detailed and substantial revision of your manuscript. I have found two minor inconsistencies that I would like you to address- in line 159 I think you mean "consent" and not "concept" and in line 249 it should be "caused by these bacteria" and "not caused these bacteria"
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Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data-- yes the method is well written 2. Presentation of results-- is good 3. How the style and organization of the paper communicates and represents key findings 4. Literature analysis or discussion -- has improved 5. Any other relevant comments
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between …
Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data-- yes the method is well written 2. Presentation of results-- is good 3. How the style and organization of the paper communicates and represents key findings 4. Literature analysis or discussion -- has improved 5. Any other relevant comments
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community. The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
The manuscript entitled" Evaluation of the Diagnostic Performance of urine dipstick test for Detection of urinary 2 tract infections in patients treated in Kenyan hospital" contains interesting results in the field and it is in line with the scope of journal studies. The paper needs modification according to the following comments: Please add years of study setup in abstract. Line 66; Moreover, culture is often less preferred by "my" change to "many" Line 72; leukocytes esterase and nitrates are the essential test parameters "and" are often used inseparably. Will change the word "and" to "Which" Line 76-77 Not clear, what do you mean by "strengthen the UTI dipstick test" Line 82 "Genital" should be lowercase "genital" Sample processing How long did it take after sample collection before the Urine …
Comments to Author
The manuscript entitled" Evaluation of the Diagnostic Performance of urine dipstick test for Detection of urinary 2 tract infections in patients treated in Kenyan hospital" contains interesting results in the field and it is in line with the scope of journal studies. The paper needs modification according to the following comments: Please add years of study setup in abstract. Line 66; Moreover, culture is often less preferred by "my" change to "many" Line 72; leukocytes esterase and nitrates are the essential test parameters "and" are often used inseparably. Will change the word "and" to "Which" Line 76-77 Not clear, what do you mean by "strengthen the UTI dipstick test" Line 82 "Genital" should be lowercase "genital" Sample processing How long did it take after sample collection before the Urine test was done? time is taken to process the sample? Ie between the time of urine collection and urine test/culture as timing can affect the result as well. How was the culture done? was it done from the dipstick sample or different sample was used? can you clarify that in the sample processing section? Line 116 statement no clear Line 123 why did you decide to choose monoculture, what happens if you have 2 different colonies The result sections. Line 135 It is difficult to understand What was your criteria for the contaminant of the dipstick Did you only test for one type of urine dipstick or more? and Why Figure 3.2 Legend interpretation; 4 - All urine dipstick parameters for UTI, does this include nitrate, LE and RBCs if yes why did you separate those. If No then please clarify Line 216 need reference
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
The manuscript entitled " Evaluation of the Diagnostic Performance of urine dipstick test for Detection of urinary tract infections in patients treated in Kenyan hospitals " is succinct, well written, and structured but it has some minor concerns: There are insufficient details of the used methods to produce a more contextualized and scientific manuscript e.g. standard microbiological procedures used for urine culture and characterization of isolates. The authors ignore the isolated bacteria. How you discriminated between contamination and infection? Lack of urine culture details, advantages and drawbacks or limitations. -The authors ignored the inclusion criteria of the enrolled patients. The type of infection whether it was hospital or community acquired (HAI OR CAI??). -The discussion …
Comments to Author
The manuscript entitled " Evaluation of the Diagnostic Performance of urine dipstick test for Detection of urinary tract infections in patients treated in Kenyan hospitals " is succinct, well written, and structured but it has some minor concerns: There are insufficient details of the used methods to produce a more contextualized and scientific manuscript e.g. standard microbiological procedures used for urine culture and characterization of isolates. The authors ignore the isolated bacteria. How you discriminated between contamination and infection? Lack of urine culture details, advantages and drawbacks or limitations. -The authors ignored the inclusion criteria of the enrolled patients. The type of infection whether it was hospital or community acquired (HAI OR CAI??). -The discussion section is lacking. I would strongly advise the authors to rewrite it.
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes