Comparative Evaluation of Dipstick Tests and Urine Microscopy Against Culture in Childhood Urinary Tract Infection: A Prospective Study

Background Urinary tract infections (UTIs) are among the most frequent bacterial infections in children and carry a risk of renal scarring, hypertension, and chronic kidney disease if not promptly diagnosed. While urine culture remains the gold standard, rapid screening tests are essential for timely management. Methods A prospective study was conducted in 178 children aged 3 months to 12 years clinically suspected of UTI. All participants underwent urine dipstick testing for leukocyte esterase (LE) and nitrites, urine microscopy, and culture. Sensitivity, specificity, predictive values, likelihood ratios, and receiver operating characteristic (ROC) curves were calculated. Results Urine culture was positive in 17.4% of cases, most commonly isolating Escherichia coli and Acinetobacter baumannii . LE showed sensitivity of 80.6% and specificity of 61.2%, while nitrite demonstrated excellent specificity (94.6%) and moderate sensitivity (74.2%). Microscopy yielded the highest sensitivity (93.5%) and negative predictive value (98.3%). Combined LE and nitrite positivity increased specificity (97.9%) and positive predictive value (86.3%) but reduced sensitivity (61.2%). ROC analysis showed the highest AUC for nitrite (0.829), followed by microscopy (0.799) and LE (0.787). Conclusion Urine microscopy is the most sensitive screening modality, while nitrite provides excellent rule-in value. Combined dipstick testing enhances specificity, supporting its integration into diagnostic algorithms alongside culture.