A Flow Cytometric and Cytochemistric Analysis of Urine to Detect Early Urinary Tract Infection
Keywords:
Urinary Tract Infections, Flow cytometry, Leucocyte Esterase, Nitrites, Bacterial counts
Abstract
Introduction: Urinary tract infections (UTI) are infections affecting any part of the urinary tract and are most commonly caused by a multitude of bacteria. Most tests used these days to detect UTI are based on chemical test strips and cultures, both of which are labor and time-intensive. The aim of our study is to establish parameters that could detect UTI with high certainty. Material & Methods: The study was conducted in the Department of Pathology of Rajiv Gandhi Super Speciality Hospital, Delhi. The samples received between January to March 2017 were included in the study. All the samples were run in the Sysmex UX 2000, a fully automated urine analyzer. Results: A total of 236 patients were registered in this study. The study participants range from 4 years to 88 years with 56% males and 44% females. Out of these 21% were positive for UTI whereas 9% were inconclusive and 70% were negative. Cutoff values for white blood cells (WBC) and bacterial counts taken were 20.2 cells/µl and 143.2 cells/µl, respectively. Flowcytometric analysis of both WBC and bacterial cells showed high sensitivity (81%) as well as high negative predictive value (NPV) of 93%. Analysis of nitrites showed 97% specificity and 81% NPV, while leucocyte esterase showed 87% specificity and 92% NPV. Conclusion: Flow cytometry-based bacterial counts, total leucocyte counts, as well as nitrites and leucocyte esterase, could be used as screening tests for early as well as subclinical urinary tract infections and will reduce the need for urine culture.References
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2. Stamm WE, Norrby SR. Urinary Tract Infections: Disease Panorama and Challenges. The Journal of Infectious Diseases. 2001;183(Supplement_1):S1-S4. doi: 10.1086/318850.
3. Akortha EE, Ibadin OK. Incidence and antibiotic susceptibility pattern of Staphylococcus aureus among patients with urinary tract infection (UTI) in UBTH Benin City, Nigeria. African Journal of Biotechnology. 2008;7(11):1637-40.
4. Amin M, Mehdinejad M, Pourdangchi Z. Study of bacteria isolated from urinary tract infections and determination of their susceptibility to antibiotics. Jundishapur Journal of Microbiology. 2009;2(3):118-23.
5. Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002;287(20):2701-10. doi: 10.1001/jama.287.20.2701.
6. Daoud Z, Afif C. Escherichia coli Isolated from Urinary Tract Infections of Lebanese Patients between 2000 and 2009: Epidemiology and Profiles of Resistance. Chemotherapy Research and Practice. 2011;2011. doi: 10.1155/2011/218431.
7. Ben-Ezra J, Bork L, McPherson RA. Evaluation of the Sysmex UF-100 automated urinalysis analyzer. Clinical Chemistry. 1998;44(1):92-5.
8. John AS, Boyd JC, Lowes AJ, Price CP. The use of urinary dipstick tests to exclude urinary tract infection. Am J Clin Pathol. 2006;126:428-36.
9. Devillé WLJM, Yzermans JC, van Duijn NP, Bezemer PD, van der Windt DAWM, Bouter LM. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urology. 2004;4:4. doi: 10.1186/1471-2490-4-4. PubMed PMID: PMC434513.
10. Simerville JA, Maxted WC, Phira JJ. Urinalysis: A comprehensive review. Am Fam Physician. 2005 Mar 15;71(6):1153-62.
11. Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The Diagnosis of Urinary Tract Infection: A Systematic Review. Deutsches Ärzteblatt International. 2010;107(21):361-7. doi: 10.3238/arztebl.2010.0361. PubMed PMID: PMC2883276.
12. Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC. Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis. The Lancet Infectious Diseases. 2010;10:240-50. doi: 10.1016/S1473-3099(10)70031-1.
13. Agpaoa VV, Mendoza JB, Fernandez AJM, Veloso JD, Bhatnagar S. Predict urinary tract infection and to estimate causative bacterial class in Philippine subspecialty hospital. J Nephrol Ther. 2015;5(2):194. doi: 10.4172/2161-0959.1000194.
14. Fully automated integrated urine analyzer UX-2000. Instructions for use. Kobe, Japan: Sysmex Corporation; 2015.
15. Khejonnit V, Pratumvinit B, Reesukumal K, Meepanya S, Pattanavin C, Wongkrajang P. Optimal criteria for microscopic review of urinalysis following use of automated urine analyzer. Clinica Chimica Acta. 2015;439:1-4. doi: https://doi.org/10.1016/j.cca.2014.09.027.
16. Clinical and Laboratory Standards Institute, Performance standards for antimicrobial susceptibility testing. CLSI document M100-S15. Wayne, PA, USA: Clinical and Laboratory Standards Institute; 15th International supplement, 2005.
17. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. The American Journal of Medicine. 2002;113(1):5-13. doi: 10.1016/S0002-9343(02)01054-9.
18. Santos JCd, Weber LP, Perez LRR. Evaluation of urinalysis parameters to predict urinary-tract infection. The Brazilian Journal of Infectious Diseases. 2007;11(5):479-81.
19. Manoni F, Fornasiero L, Ercolin M, Tinello A, Ferrian M, Hoffer P, et al. Cutoff values for bacteria and leukocytes for urine flow cytometer Sysmex UF-1000i in urinary tract infections. Diagnostic Microbiology and Infectious Disease.65(2):103-7. doi: 10.1016/j.diagmicrobio.2009.06.003.
20. 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. Clinica Chimica Acta. 2010;411(15):1137-42..
21. Broeren MAC, Bahçeci S, Vader HL, Arents NLA. Screening for Urinary Tract Infection with the Sysmex UF-1000i Urine Flow Cytometer. Journal of Clinical Microbiology. 2011;49(3):1025-9..
22. Kim SY, Kim YJ, Lee SM, Hwang SH, Kim HH, Son HC, et al. Evaluation of the Sysmex UF-100 Urine Cell Analyzer as a Screening Test to Reduce the Need for Urine Cultures for Community-Acquired Urinary Tract Infection. American Journal of Clinical Pathology. 2007;128(6):922-5. doi: 10.1309/4606EC29U50DVAFY.
23. Yang C-C, Chang S-J, Yang SS-D, Lin C-D, Peng C-H. Rapid diagnosis of uncomplicated urinary tract infection with laser flow cytometry. Urological Science. 2016;27(3):135-9. doi: https://doi.org/10.1016/j.urols.2016.09.001.
Published
2020-01-28
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