The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border
© 2015 John Wiley & Sons Ltd. Objective: Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibioti...
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th-mahidol.360662018-11-23T17:34:44Z The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border Lauren Chalmers Jessica Cross Cindy S. Chu Aung Pyae Phyo Margreet Trip Clare Ling Verena Carrara Wanitda Watthanaworawit Lily Keereecharoen Borimas Hanboonkunupakarn François Nosten Rose Mcgready Mahidol University Nuffield Department of Clinical Medicine Immunology and Microbiology Medicine © 2015 John Wiley & Sons Ltd. Objective: Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. Methods: One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >105 CFU/ml. Results: In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells <5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. Conclusion: One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy. 2018-11-23T10:15:12Z 2018-11-23T10:15:12Z 2015-10-01 Article Tropical Medicine and International Health. Vol.20, No.10 (2015), 1281-1289 10.1111/tmi.12541 13653156 13602276 2-s2.0-84941146084 https://repository.li.mahidol.ac.th/handle/123456789/36066 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84941146084&origin=inward |
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Immunology and Microbiology Medicine Lauren Chalmers Jessica Cross Cindy S. Chu Aung Pyae Phyo Margreet Trip Clare Ling Verena Carrara Wanitda Watthanaworawit Lily Keereecharoen Borimas Hanboonkunupakarn François Nosten Rose Mcgready The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border |
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© 2015 John Wiley & Sons Ltd. Objective: Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. Methods: One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >105 CFU/ml. Results: In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells <5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. Conclusion: One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy. |
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Mahidol University |
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Mahidol University Lauren Chalmers Jessica Cross Cindy S. Chu Aung Pyae Phyo Margreet Trip Clare Ling Verena Carrara Wanitda Watthanaworawit Lily Keereecharoen Borimas Hanboonkunupakarn François Nosten Rose Mcgready |
format |
Article |
author |
Lauren Chalmers Jessica Cross Cindy S. Chu Aung Pyae Phyo Margreet Trip Clare Ling Verena Carrara Wanitda Watthanaworawit Lily Keereecharoen Borimas Hanboonkunupakarn François Nosten Rose Mcgready |
author_sort |
Lauren Chalmers |
title |
The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border |
title_short |
The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border |
title_full |
The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border |
title_fullStr |
The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border |
title_full_unstemmed |
The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border |
title_sort |
role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the thailand-myanmar border |
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2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/36066 |
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1763490205030940672 |