ACCURACY OF URINE DIPSTICK TEST TO DIAGNOSTIC SYMPTOMATIC NOSOCOMIAL URINARY TRACT INFECTION AND RESISTANCE PATTERN OF NOSOCOMIAL UTI IN HAJI ADAM MALIK GENERAL HOSPITAL MEDAN

Citra Abdi Negara, Fransciscus Ginting, Rina Yunita, Putri Eyanoer

Abstract


Background : Urinary tract infections (UTI) is one of the most common nosocomial infections and many of these infections are associated with microorganisms that are resistant to antimicrobial. Currently, urine culture considered to be a gold standard to diagnose UTI. The usage of urine dipstick as a screening tool for patients suspected with symptomatic nosocomial UTI has been used widely but performance characteristic of dipstick is still questionable. To determine accuration of dipstick urine test compared with urine culture for diagnosis of symptomatic nosocomial UTI as a gold standard, identify etiological microorganisms and antimicrobial drug resistance rate in bacterial pathogens causing symptomatic nosocomial UTI. Method : The study design is diagnostic test with standard reference urine culture that involved 151 patients with signs and symptoms of nosocomial UTI. Result : From 151 samples, 75 male (49.66%) and 76 female (50.33%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of dipstick urine test in diagnosing symptomatic nosocomial UTI was found to be 89.28%, 56.71%, 72.11% and 80.85% respectively. A total 91 isolates (60.26%) were successfully isolated from urine samples with highest prevalence of Escherichia coli 35 isolate (38.48%) followed by Enterococcus spp. 18 isolate (19.76%), Klebsiella pneumonia 13 isolates (14.28%), Pseudomonas aeruginosa 7 isolate (7.69%), Acinetobacter baumanii 4 isolate (4.39%) dan others 14 isolate (15.3%). Antimicrobial empiric for symptomatic nosocomial UTI with level of resistance under 20% are amikacin and fosfomycin.  Conclusion: The urine dipstick test can to be useful as a screening test to role-out symptomatic nosocomial UTI and can reduce the need urine culture and avoid the prescription of ineffective antimicrobial. The most germ cause symptomatic nosocomial UTI is Escherichia coli. The empirical therapy with favourable sensitivity for all bacterial pathogens only amikacin and fosfomycin.


Keywords


Dipstick urine, negative predictive value, symptomatic nosocomial UTI, antimikroba resistance

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References


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