The Usage of Uristix in Screening Bacteriuria in Elderly Chinese In-patients

†Current address: Consultant Geriatrician, Department of Geriatric Medicine, Prince of Wales & Prince Henry Hospitals, Little Bay NSW 2036, Sydney, Australia. Summary Bacteriuria is a common problem that occurs in the aged. In developing countries and in countries where the health budget is tight, an effective and efficient screening test for bacteriuria may be a costsaver, reducing the demand for mid-stream urine (MSU). It may also enhance early treatment (in cases suspected of urinary tract infections), thus reducing morbidity and mortality. In our hospital, where the average length of stay is extremely short, 38% of patients have been discharged when their MSU results returned. With this background, a study was carried out to evaluate the usefulness of Uristix in screening bacteriuria in clinical settings and to survey the frequency of asymptomatic bacteriuria as against urinary tract infections (UTI) in hospitalised elderly patients. In 100 elderly Chinese patients admitted, it was found that Uristix was both highly sensitive (95.8%) and specific (100%) if the recommended disjunctive pairing method was used (Urisrix positive if nitrite, leucocyte esterase or both were positive). It must however be stressed that the interpretation of results should always be in the larger clinical context. In the setting of low clinical suspicion of UTI, a negative Uristix test can reasonably negate the necessity of a MSU. Conversely, high clinical suspicion of UTI, coupled with positive Uristix, should prompt early treatment while awaiting for sensitivity. For those where Uristix disputes with clinical suspicion, a MSU should be ordered. If Uristix is being introduced wisely as a screening test, some unnecessary MSU investigations can be avoided, hence saving money (a MSU is 28 times more expensive). Meanwhile, in patients with clinical suspicion of UTI being tested Uristix positive, early treatment may mean earlier discharge if situation permits before MSU returns, hence saving bed-cost and the inconvenience of being called back when MSU returned positive after patients are discharged.