Urine Analysis as a Reliable Indicator of a Urinary Tract Infection: A Cross-Sectional Study

BACKGROUND: Urinary tract infection (UTI) is one of the most common clinical entities encountered by physicians in a healthcare setup. The fact that there are no definitive criteria for diagnosing a UTI, leads to overdiagnosis and hence excessive use of antibiotics which eventually leads to multi-drug resistant microorganisms. OBJECTIVES: To determine the correlation of positive urine analysis based on greater than 10 white blood cell count (WBC)/high power field (HPF) with a true UTI according to our operational definition. METHODS: This study is a cross-sectional retrospective study. The patient population to be studied consists of in-patients and patients being evaluated in the emergency room in the University of Louisville Healthcare (UofL Health) network. A target of 100 patients was set as a goal for our study. A non-randomized consecutive sampling was done. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Descriptive statistics, including means ± SDs for quantitative variables and frequencies/percentages for qualitative variables, were computed. Results: Our study included 100 patients, with a gender distribution of 48% male and 52% female, and a mean age of 59.62 years (SD = 17.56, range: 20-94 years). UTI diagnoses were established in 17% of cases as per our operational definition in which the majority were female (76%). Symptomatic presentation was observed in 23% of the cohort, while the majority (77%) remained asymptomatic. CONCLUSION: Urine analysis is not always a true indicator of a UTI and hence hospital policy of doing a reflex culture to a positive urine analysis should be discouraged as it leads to overdiagnosis and, hence, unnecessary use of antibiotics.