Abstract
Background:
Diagnostic urinary tract infection (UTI) studies have primarily been performed among female patients.
Aim:
To create a diagnostic algorithm for male general practice patients suspected of UTI.
Design and setting:
Surveillance study in the Dutch Sentinel General Practice Network.
Method:
Clinical information and dipstick results were collected from 603 patients. Algorithm-predicted care was compared with care as usual in terms of sensitivity (antibiotic recommended when UTI was confirmed) and specificity (no antibiotic recommended when no UTI was observed).
Results:
Complete information was available from 490/603 (81 %) males, of whom 66 % (321/490) had a UTI. A diagnostic algorithm recommending antimicrobial prescription in the case of a positive nitrite test or a positive leukocyte esterase test in males aged >= 60 years, had a positive predictive value (PPV) of 83 % (95 % confidence interval [CI] = 78 to 87) and a negative predictive value (NPV) of 60 % (95 % CI = 52 to 66), respectively (area under the ROC curve: 0.78, 95 % CI = 0.74 to 0.82). When both dipstick results were positive in males aged >= 60 years, PPV increased to 90 % (95 % CI = 83 to 94), whereas NPV was highest in males >= 60 years with negative dipstick results (71 %, 95 % CI = 59 to 81). Sensitivity and specificity of predicted UTI care and usual care did not differ (75 % versus 79 %, P = 0.30, and 70 % versus 63 %, P = 0.17, respectively).
Conclusion:
UTI care provided to Dutch male GP patients is as accurate as predicted care from a diagnostic algorithm. The studied clinical information and dipstick tests are useful for ruling in UTI in males, but have limited value in ruling out this diagnosis.
Original language | English |
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Pages (from-to) | 780-786 |
Number of pages | 2 |
Journal | British Journal of General Practice |
Volume | 62 |
Issue number | 604 |
DOIs | |
Publication status | Published - Nov 2012 |
Keywords
- CLINICAL SCORES
- ACUTE CYSTITIS
- TESTS
- MEN
- SPECIFICITY
- SENSITIVITY
- MANAGEMENT
- DIPSTICKS
- WOMEN