Comparison of urine Gram stain and urine culture to diagnose urinary tract infection in children
Keywords:
Gram stain, urine culture, urinary tract infection
Abstract
Background Urinary tract infection (UTI) are due to pathogeninvasion of the urinary tract. The upper or lower tract may be
affected, depending on the presence of infection in the kidney,
or bladder and urethra. Infection of urinary tract affect up to
10% of children and are the most common bacterial infection in
infants and young children worldwide. The prevalence of UTI is
3-5% in girls and 1 % in boys. Urine culture is considered to be
the gold standard diagnostic test for UTI. However, Gram stains
of uncentrifuged urine have been done in rural health centers and
laboratories in peripheral areas that lack facilities to evaluate urine
specimens. Gram stains of urine may be an effective method for
ruling out UTI in rural health center patients, thus saving time
and money in impoverished settings.
Objective To compare urine Gram stain and urine culture as
diagnostic tests for UTI in children.
Methods This cross-sectional study was held in H. Adam Malik
Hospital from May to June 2010. The 54 participants were aged
0 - 14 years, suspected to have UTI and recruited by consecutive
sampling. Urine was collected after the external urethral orifice
was cleaned. A drop of the urine specimen was Gram stained
and examined by a light microscope, while the remainder of the
specimen was used for laboratory urine cultures. If Gram negative
bacteria were observed by Gram stain, we considered the subject
to have UTI.
Results The sensitivity and specificity of urine Gram stain
compared to urine culture were 88% and 100%, respectively. The
positive predictive value (PPV) and negative predictive value
(NPV) were 100% and 90%, respectively.
Conclusion Urine Gram stain may be a good alternative to urine
culture for diagnosing UTI in children living in areas with limited
health care facilities.
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Craig JC. Absolute and relative accuracy of rapid urine test
for urinary tract infection in children: a meta-analysis. Lancet
Infect Dis. 2010;10:240-50.
3. Smith G. Management of urinary tract infection. Current
Paediatrics. 2004;14:556-62.
4. Kosnadi L. Studi kolaboratif pola penyakit ginjal anak di
Indonesia. In: Kosnadi L, Soeroso S, Suyitno H, editors.
Naskah lengkap Simposium Nasional IV Nefrologi Anak
clan Peningkatan Berkala Ilmu Kesehatan Anak ke 6; 1989
Juni 23-24; Semarang. Bidang Nefrologi; 1989. p. 73-90.
5. Tambunan T, Suarta K, Trihono PP, Pardede SO. Infeksi
saluran kemih kompleks di Poliklinik Ginjal Anak RSUP
Nasional Dr. Ciptomangunkusumo, Jakarta. Maj Kedokt
Indones. 2000;50:372-6.
6. Luco M, Lizama M, Reichard C, Hirsch T. Urine microscopy
as screen for urinary tract infections in a pediatric emergency
unit in Chile. Pediatr Emerg Care. 2006; 22:705-9.
7. Rusdidjas, Ramayati R. Infeksi saluran kemih. In: Alatas
H, Tambunan T, Trihono PP, Pardede SO, editors. Buku
ajar nefrologi anak. 2nd ed. Jakarta: Ikatan Dokter Anak
Indonesia; 2002. p. 142-63 .
8. Hari P, Srivastava RN. Urinary tract infection. In: Srivastava
RN, Bagga A, editors. Pediatric nephrology. 5th ed. New
124 • Paediatr lndones, Vol. 53, No. 2, March 201 3
9.
Delhi: Jaypee Brothers Medical Publishers; 2011. p. 273-
300.
Gardezi A, Mirza HS, Khursheed U, Ferooque M, Waqar A.
Microscopy of gram stained uncentrifuged drop of urine for
presumptive diagnosis of urinary tract infections. Pak J Pathol.
2006;17:111-4.
10. Elder SJ. Urologic disorder in infants and children. In:
Berhman RE, Kliegman RM, Jenson HB, editors. Nelson
textbook of pediatrics. 17th ed. Philadelphia: WB Saunders;
2000. p. 1785-90.
11. Al-Hasan MN, Eckel-Passow JE, Baddour LM. Bacteremia
complicating gram-negative urinary tract infections: a
population-based study. J Inf. 2010;60:278-85.
12. Ismaili K, Lolin K, Damry N, Alexander M, Lepage P, Hall M.
Febrile urinary tract infections in O-to-3-month-old infants:
a prospective follow-up study. J Pediatr. 2011;158:91-4.
13. Gorelick MH, Shaw KN. Screening tests for urinary tract
infection: a meta-analysis. Pediatrics. 1999; 104:e54.
14. Vaillancourt S, McGillivray D, Zhang X, Kramer MS. To clean
or not to clean: effect on contamination rates in midstream
urine collections in toilet-trained children. Pediatrics.
2007;119:el288-93.
15. Dayan PS, Chamberlain JM, Boenning D, Adirim T, Schor
JA, Klein BL. A comparison of initial to the later stream
urine in children catheterized to evaluate for a urinary tract
infection. Pediatr Emerg Care. 2000;16:88-90.
16. Yildirim M, Sahin I, Kucukbayrak A, Oksuz S, Acar S, Yavuz
MT. The validity of the rapidly diagnostic tests for early
detection of urinary tract infection. Duzce Tip Fakultesi
Dergisi. 2008;3:39-42.
17. Cardoso CL, Muraro CB, Siqueira VL, Guilhermetti M.
Simplified technique for detection of significant bacteriuria
by microscopic examination of urine. J Clin Microbiol.
1998;36:820-3.
Published
2013-04-30
How to Cite
1.
Putri A, Rina O, Rosmayanti R, Ramayati R, Rusdidjas R. Comparison of urine Gram stain and urine culture to diagnose urinary tract infection in children. PI [Internet]. 30Apr.2013 [cited 27Apr.2024];53(2):121-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/265
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-04-30
Accepted 2016-08-21
Published 2013-04-30
