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Reliability of Symptoms and Dipstick for Postoperative Catheter-Associated Urinary Tract Infections

Holthaus, Emily A., MD*; Ferrando, Cecile A., MD, MPH*; Jelovsek, J. Eric, MD, MMEd; Barber, Matthew D., MD, MHS

Female Pelvic Medicine & Reconstructive Surgery: April 30, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000739
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Objective The aim of the study was to determine the diagnostic reliability of patient symptoms and urine dipstick results, including blood, leukocyte esterase, and nitrite, in diagnosing postoperative catheter-associated urinary tract infections (CAUTIs) after gynecologic surgery.

Methods A prospective cohort study of patients undergoing gynecologic surgeries who required short-term (>24 hours) postoperative catheterization was conducted. Patients completed a questionnaire regarding symptoms. Urine dipstick analysis was completed on catheterized urine samples and urine was sent for culture for all patients. Positive likelihood ratios (LRs) were used to examine diagnostic reliability of patient symptoms and urine dipstick results in diagnosing postoperative CAUTIs.

Results Fifty-seven patients with postoperative short-term indwelling catheterization were recruited, 25 (44%) of whom had CAUTIs diagnosed by urine culture at recruitment and 32 (56%) of whom did not have CAUTIs. Urine dipstick parameters were found to successfully diagnose CAUTIs, with positive LRs of 1.44 (95% confidence interval [CI], 1.04–1.99), 6.77 (95% CI, 2.23–20.52), and 9.47 (95% CI, 1.23–72.69) for blood, leukocyte esterase, and nitrite, respectively. The combination of leukocyte esterase and nitrite yielded a positive LR of 9.48 (95% CI, 2.62–34.25). Individual symptoms, alone or in combination, did not successfully diagnose positive urine culture (positive LRs <1.8).

Conclusions Urine dipstick parameters are reliable diagnostic tests for diagnosing postoperative CAUTIs after gynecologic surgery, particularly when in combination. Patient symptoms have little diagnostic value for positive urine cultures in catheterized patients after gynecologic surgery.

From the *Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH; and

Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.

Correspondence: Emily Holthaus, MD, 9500 Euclid Ave, Desk A81, Cleveland, OH 44195. E-mail: holthae@ccf.org.

The authors have declared they have no conflicts of interest.

The study was supported by the Cleveland Clinic Research Program Committee. The sponsor had no role in study design, data collection or interpretation, writing of report, or decision to submit the article for submission.

These data have not been presented at any meetings beyond the Cleveland Clinic Lerner College of Medicine Thesis Defense.

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