SYMPTOMATIC URINARY-TRACT INFECTION IN WOMEN IN PRIMARY HEALTH-CARE -BACTERIOLOGICAL, CLINICAL AND DIAGNOSTIC ASPECTS IN RELATION TO HOST RESPONSE TO INFECTION

Objective - To evaluate rapid diagnostic tests for bacteriuria in wome n with symptoms of urinary tract infection (UTI), and to analyse bacte riological and clinical findings in relation to host response to infec tion. Design - Prospective study of symptomatic UTI in women. Setting - Primary health care centres. Patients - 819 women with signs and sym ptoms suggestive of UTI. Main outcome measures - History of UTI and cl inical findings were recorded. After randomization but before antibiot ic treatment, urine specimens were analysed for pyuria by sediment mic roscopy and for nitrite using a test strip, and cultures were performe d. The systemic inflammatory response was assessed by C-reactive prote in (CRP), erythrocyte sedimentation rate, and total white blood cell c ount. Results - The combined use of tests for pyuria and nitrite resul ted in a high sensitivity (0.93) and efficacy (0.85) when the prevalen ce of bacteriuria was 0.89, Escherichia coli and Staphylococcus saprop hyticus accounted for 93% of the urinary isolates. Significantly more patients infected with S. saprophyticus than E. coli complained of dys uria (p<0.05), frequency (p<0.05) or flank pain (p<0.01). CRP agreed b est with the clinical diagnosis of acute pyclonephritis. Conclusions - In women with a high probability of bacteriuria, i.e. those with symp toms of lower UTI, examination for pyuria and urinary nitrite offers h igh diagnostic efficacy. If either or both tests are positive urine cu ltures can be omitted.