Home Screening of presumptive urinary tract infections by the automated urine sediment analyser sediMAX
Article
Licensed
Unlicensed Requires Authentication

Screening of presumptive urinary tract infections by the automated urine sediment analyser sediMAX

  • Andrea Tessari EMAIL logo , Nicoletta Osti and Marino Scarin
Published/Copyright: October 28, 2015
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 53 Issue s2

Abstract

Background: Urinary tract infections (UTI) are among the most common bacterial infections and urine samples represent a large proportion of the specimens processed in clinical microbiology laboratories, up to 80% of which, however, yield negative results. Automated microscopy is widely used for urine sediment analysis and has recently been evaluated in a few studies for bacteriological screening of urine samples, achieving high levels of performance.

Methods: We present a study in which urine samples from both inpatients and outpatients, with either clean-catch or indwelling catheter urine samples, were screened for UTI by urine culture, as the reference method, and the automated urine analyser sediMAX, for the detection of bacteria, leukocytes and yeasts.

Results: In total, 3443 urine samples were evaluated. When a single algorithm was adopted for sediMAX to screen the total patient population, 96.4% sensitivity, 75.4% specificity, 57.8% positive predictive value, and 98.4% negative predictive value were found. However, for male outpatients and all patients with indwelling catheter other algorithms were necessary to improve performances. Altogether, with sediMAX false negative rate was 2.4% and false positive rate was 27.6%. In addition, 54% of the investigated samples could have avoided urine culture.

Conclusions: After the identification of specific algorithms for different patient subgroups, the automated urine analyser sediMAX can be reliably employed in the screening of UTI.

Keywords: automated microscopy; bacteriura; leukocyturia; urinary tract infection; urine culture
Corresponding author: Andrea Tessari, Microbiology Unit, ULSS 18 Rovigo Hospital, Viale Tre Martiri 140, 45100 Rovigo, Italy, Phone: +39 0425 393371, Fax: +39 0425 394414, E-mail:

References

1. Scottish Intercollegiate Guidelines Network. Management of suspected bacterial urinary tract infection in adult. A national clinical guideline. Edinburg, Scotland: Scottish Intercollegiate Guidelines Network, 2006.Search in Google Scholar

2. Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis 2004;38:1150–8.10.1086/383029Search in Google Scholar PubMed

3. De Rosa R, Grosso S, Bruschetta G, Avolio M, Stano P, Modolo ML, et al. Evaluation of the Sysmex UF1000i flow cytometer for ruling out bacterial urinary tract infection. Clin Chim Acta 2010;411:1137–42.10.1016/j.cca.2010.03.027Search in Google Scholar PubMed

4. Jolkkonen S, Paattiniemi E, Karpanoja P, Sarkkinen H. Screening of urine samples by flow cytometry reduces the need for culture. J Clin Microbiol 2010;48:3117–21.10.1128/JCM.00617-10Search in Google Scholar PubMed PubMed Central

5. Franz M, Horl WH. Common errors in diagnosis and management of urinary tract infection. I: pathophysiology and diagnostic techniques. Nephrol Dial Transplant 1999;14:2746–53.10.1093/ndt/14.11.2746Search in Google Scholar PubMed

6. Zaman Z, Fogazzi GB, Garigali G, Croci MD, Bayer G, Kranicz T. Urine sediment analysis: analytical and diagnostic performance of sediMAX – A new automated microscopy image-based urine sediment analyser. Clin Chim Acta 2010;411:147–54.10.1016/j.cca.2009.10.018Search in Google Scholar PubMed

7. Cavallo JD, Tenke P. Urinary tract infections. In: Cornaglia G, Courcol R, Herrmann JL, Kahlmeter G, Peigue-Lafeuille H, Vila J, editors. European manual of clinical microbiology, 1st ed. Paris – Basel: SFM – ESCMID, 2012:133–43.Search in Google Scholar

8. Devillè W, Yzermans JC, van Duijn NP, Bezemer PD, van der Windt D, Bouter LM. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urol 2004;4:4.Search in Google Scholar

9. Ilki A, Bekdemir P, Ulger N, Soyletir G. Rapid reporting of urine culture results: impact of the uro-quick screening system. New Microbiol 2010;33:147–53.Search in Google Scholar

10. Falbo R, Sala MR, Signorelli S, Venturi N, Signorini S, Brambilla P. Bacteriuria screening by automated whole-field image-based microscopy reduces the number of urine cultures. J Clin Microbiol 2012;50:1427–9.10.1128/JCM.06003-11Search in Google Scholar PubMed PubMed Central

11. Karakukcu C, Kayman T, Ozturk A, Torun YA. Analytic performance of bacteriuria and leukocyturia obtained by UriSed in culture positive urinary tract infections. Clin Lab 2012;58:107–11.Search in Google Scholar

12. Martinez MH, Bottini PV, Levy CE, Garlipp CR. UriSed as a screening tool for presumptive diagnosis of urinary tract infection. Clin Chim Acta 2013;425:77–9.10.1016/j.cca.2013.07.020Search in Google Scholar PubMed

13. Kouri T, Fogazzi G, Gant G, et al. European Urina1ysis Guidelines. Scand J Clin Lab Invest 2000;60(Suppl 231):1–97.10.1080/00365513.2000.12056993Search in Google Scholar

14. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837–45.10.2307/2531595Search in Google Scholar

15. Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993;39:561–77.10.1093/clinchem/39.4.561Search in Google Scholar

16. Hosner DW, Lemeshow S, Sturdivant RX. Applied logistic regression, 3rd ed. New Jersey: Wiley, 2013:500.10.1002/9781118548387Search in Google Scholar

17. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 1998;17:857–72.10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-ESearch in Google Scholar

18. Altman DG. Practical statistics for medical research, 1st ed. London: Chapman & Hall, 1990:624.10.1201/9780429258589Search in Google Scholar

19. Broeren MA, Bahceci S, Vader HL, Artents NL. 2011. Screening for urinary tract infection with the Sysmex UF-1000i urine flow cytometer. J Clin Microbiol 2011;49:1025–9.10.1128/JCM.01669-10Search in Google Scholar

20. Manoni F, Valverde S, Antico F, Salvadego MM, Giacomini A, Gessoni G. Field evaluation of a second-generation cytometer UF-100 in diagnosis of acute urinary tract infections in adult patients. Clin Microbiol Infect 2002;8:662–8.10.1046/j.1469-0691.2002.00452.xSearch in Google Scholar

21. Pieretti B, Brunati P, Pini B, Colzani C, Congedo P, Rocchi M, et al. Diagnosis of bacteriuria and leukocyturia by automated flow cytometry compared with urine culture. J Clin Microbiol 2010;48:3990–6.10.1128/JCM.00975-10Search in Google Scholar

22. Wang J, Zhang Y, Xu DW, Shao WJ, Lu Y. Evaluation of the Sysmex UF-1000i for the Diagnosis of Urinary Tract Infection. Am J Clin Pathol 2010;133:577–82.10.1309/AJCP1GT2JXOCQBCZSearch in Google Scholar

23. Luciano R, Piga S, Federico L, Argentieri M, Fina F, Cuttini M, et al. Development of a score based on urinalysis to improve the management of urinary tract infection in children. Chim Clin Acta 2012;413:478–82.10.1016/j.cca.2011.11.005Search in Google Scholar

24. Parta M, Hudson BY, Le TP, Ittmann M, Musher DM, Stager C. IRIS iQ200 workstation as a screen for performing urine culture. Diagn Microbiol Infect Dis 2013;75:5–8.10.1016/j.diagmicrobio.2012.08.026Search in Google Scholar

25. Stürenburg E, Kramer J, Schön G, Cachovan G, Sobottkaa I. Detection of significant bacteriuria by use of the iQ200 automated urine microscope. J Clin Microbiol 2014;52:2855–60.10.1128/JCM.00112-14Search in Google Scholar

26. Ma J, Wang C, Yue J, Li M, Zhang H, Ma X, et al. Clinical laboratory urine analysis: comparison of the UriSed automated microscopic analyzer and the manual microscopy. Clin Lab 2013;59:1297–303.10.7754/Clin.Lab.2013.121128Search in Google Scholar

27. Bottini PV, Martinez MH, Garlipp CR. Urinalysis: comparison between microscopic analysis and a new automated microscopy image-based urine sediment instrument. Clin Lab 2014;60:693–7.10.7754/Clin.Lab.2013.130725Search in Google Scholar PubMed

28. Grude N, Tveten Y, Kristiansen BE. Urinary tract infections in Norway: bacterial etiology and susceptibility. A retrospective study of clinical isolates. Clin Microbiol Infect 2001;7:543–7.10.1046/j.1198-743x.2001.00306.xSearch in Google Scholar

29. Magliano E, Grazioli V, Deflorio L, Leuci AI, Mattina R, Romano P, et al. Gender and age-dependent etiology of community-acquired urinary tract infections. ScientificWorldJournal 2012:349597.10.1100/2012/349597Search in Google Scholar PubMed PubMed Central

30. Nys S, van Merode T, Bartelds AIM, Stobbering EE. Urinary tract infections in general practice patients: diagnostic tests versus bacteriological culture. J Antimicrob Chemother 2006;57:955–8.10.1093/jac/dkl082Search in Google Scholar PubMed

31. Kauffman CA. Candiduria. Clin Infec Dis 2005;41:S371–6.10.1086/430918Search in Google Scholar PubMed

32. Tambyah PA, Maki DG. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160:673–7.Search in Google Scholar

33. Murray PR, Smith TB, McKinney Jr T. Clinical evaluation of three urine screening tests. J Clin Microbiol 1987;25:467–70.10.1128/jcm.25.3.467-470.1987Search in Google Scholar PubMed PubMed Central

34. Grabe M, Bjerklund-Johansen TE, Botto H, Wullt B, Çek M, Naber KG, et al. European Association of Urology. Guidelines on urological infections. 2013. Available from: http://uroweb.org/wp-content/uploads/18_Urological-infections_LR.pdf. Accessed: 20 Oct 2014.Search in Google Scholar

Received: 2015-3-31
Accepted: 2015-9-11
Published Online: 2015-10-28
Published in Print: 2015-11-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Urinary sediment: still an important diagnostic tool
  4. Introduction
  5. A history of urine microscopy
  6. The modern view on some urinary sediment particles
  7. Lipiduria – with special relevance to Fabry disease
  8. Cylindruria
  9. Crystalluria
  10. External quality control programs on urinary sediment
  11. External quality assessment of urine particle identification: a Northern European experience
  12. The Italian External Quality Assessment (EQA) program on urinary sediment: results of the period 2012–2015
  13. Recent advances in the automation of urinary sediment analysis
  14. Screening of presumptive urinary tract infections by the automated urine sediment analyser sediMAX
  15. Automated urine screening devices make urine sediment microscopy in diagnostic laboratories economically viable
https://doi.org/10.1515/cclm-2015-0902
Keywords for this article
automated microscopy; bacteriura; leukocyturia; urinary tract infection; urine culture

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Urinary sediment: still an important diagnostic tool
  4. Introduction
  5. A history of urine microscopy
  6. The modern view on some urinary sediment particles
  7. Lipiduria – with special relevance to Fabry disease
  8. Cylindruria
  9. Crystalluria
  10. External quality control programs on urinary sediment
  11. External quality assessment of urine particle identification: a Northern European experience
  12. The Italian External Quality Assessment (EQA) program on urinary sediment: results of the period 2012–2015
  13. Recent advances in the automation of urinary sediment analysis
  14. Screening of presumptive urinary tract infections by the automated urine sediment analyser sediMAX
  15. Automated urine screening devices make urine sediment microscopy in diagnostic laboratories economically viable
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 12.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2015-0902/html
Scroll to top button