Cost effectiveness of screening tests for UTI in CKD population

UTI is the most common hospital acquired infections, accounting for 35% in hospitalized patients. Early diagnosis and prompt treatment of UTI in CKD patients is necessary to prevent grievous complications. The objective of this study is to determine diagnostic accuracy of multi dipstick tests for detecting UTI in CKD population and study spectrum of UTI in CKD. CKD patients attending Nephrology Department with Urinary tract infection symptoms are taken as study population from March 2014 to June 2014. Midstream urine samples were subjected to routine screening with dipsticks (leucocyte esterase, nitrite test). Wet mount examination for pus cells, Culture & sensitivity was performed. Of the 100 patients, M: F 51:49. Etiology of CKD was DN 38, CIN 25, Obstruction in 14, CGN – 29 ADPKD 4 and VUR 2. No. of patients in CKD stage 17, stage2 16, stage3 -18, stage4 19 and stage 5 -39. Sensitivity of nitrite test 62, specificity 86, PPV 81, NPV 70%. Leucocyte esterase test sensitivity 92%, specificity 56%, PPV 68% and NPV 88%. Both tests combine sensitivity 92%, specificity 54%, PPV 67%, NPV 87%. Escherichia coli was found in 18, Klebsiella 14, enterococcus 9, pseudomonas 2, Staphylococcus aureus 2, candida 2 ,CONS 1, Streptococcus pyogenes 1 and citrobacter 1. Culture sterile in 50. In our population, UTIs are common in DN patients. CKD stages 4&5 constituted majority. Leucocyte esterase test has good sensitivity and NPV value compared to nitrite test hence leucocyte esterase as screening test can be entertained.