Abnormal Urinalysis Is a Poor Predictor of Clinical UTI

In a retrospective cohort study, leukocyte esterase, pyuria, nitrite, and bacteriuria all had positive predictive values for UTI below 50%.

Urinalysis (UA) is a common screening tool to detect urinary tract infection (UTI) — and if the UA is abnormal, a reflex urine culture (RUC) is obtained in up to 50% of hospitals. However, UA has not been rigorously studied or validated for this purpose; thus, investigators conducted a retrospective cohort study among adult patients without indwelling urinary catheters at five U.S. hospitals between 2017 and 2019. Among 3392 patients randomly selected for chart review, 723 met criteria for a UTI (defined as >10⁵ colony-forming units/mL on culture with genitourinary symptoms and at least two signs, including fever, rigors, hypotension, nausea or vomiting, delirium, or new urologic obstruction).

Among individual UA parameters, the positive pre…

Reviewing Author

Neil M. Ampel, MD

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Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Abnormal Urinalysis Is a Poor Predictor of Clinical UTI

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Reviewing Author