A Comparative Analysis of Point-of-Care Dipstick Testing with Culture for Detection of Urinary Tract Infection

Aqsa Ashiq; Hifsa Mobeen; Wajiha Zafar; Tayyaba Ghafoor; Ahmad Salih; Tehreem Fatima; Asma Fatima

doi:10.61919/2s76y842

Authors

Aqsa Ashiq DMLT, Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan Author
Hifsa Mobeen Senior Lecturer DMLT-FAHS, Superior University, Lahore, Pakistan / PhD Scholar, Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan Author
Wajiha Zafar DMLT, Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan Author
Tayyaba Ghafoor DMLT, Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan Author
Ahmad Salih DMLT, Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan Author
Tehreem Fatima DMLT, Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan Author
Asma Fatima PhD Scholar, Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan Author

DOI:

https://doi.org/10.61919/2s76y842

Keywords:

Urinary Tract Infection; Urine Dipstick Test; Urine Culture; Leukocyte Esterase; Nitrite; Diagnostic Accuracy

Abstract

Background: Urinary tract infections are among the most frequent bacterial infections encountered in clinical practice and require timely diagnosis to guide appropriate patient management. Although urine culture remains the reference standard for confirming infection, its longer turnaround time may delay early clinical decision-making. Point-of-care urine dipstick testing provides a rapid and low-cost screening option by detecting leukocyte esterase and nitrite, which serve as indirect markers of urinary inflammation and bacteriuria. Objective: This study aimed to evaluate the diagnostic accuracy of combined leukocyte esterase and/or nitrite urine dipstick testing compared with urine culture for the detection of urinary tract infection. Methods: A comparative cross-sectional diagnostic accuracy study was conducted on 100 urine samples collected from clinically suspected urinary tract infection cases. Each sample was analyzed using urine dipstick testing and standard urine culture. Dipstick results were considered positive when leukocyte esterase and/or nitrite showed positivity. Urine culture was used as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were calculated. Results: Urine culture was positive in 60 samples and negative in 40 samples. Dipstick testing identified 68 positive and 32 negative samples. Compared with culture, dipstick testing produced 48 true-positive, 20 false-positive, 20 true-negative, and 12 false-negative results. Sensitivity was 80.0%, specificity 50.0%, positive predictive value 70.6%, negative predictive value 62.5%, and diagnostic accuracy 68.0%. Conclusion: Combined leukocyte esterase and/or nitrite dipstick testing is useful as a rapid initial screening method for suspected urinary tract infection, but urine culture remains essential for definitive diagnosis and antimicrobial guidance.

References

1. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13:269-284.

2. Crader MF, Bacteriuria KAL SB. StatPearls Publishing; 2023.

3. Lundberg J, Weitzberg E, Cole JA, Benjamin N. Nitrate, bacteria and human health. Clin Microbiol Infect. 2004;10(7):593-602.

4. Almuhanna HS, Alshammari HM, Alshammari AA, Alshammari RA, Alshammari SA, Alshammari MA. Comparison between urine dipstick and microscopic urinalysis with urine culture to evaluate sensitivity and specificity in diagnosing urinary tract infection. Cureus. 2024;16.

5. Ahmed MA, et al. Diagnostic accuracy of urine dipstick in detection of urinary tract infection keeping urine culture as gold standard. J Clin Lab Anal. 2020;27.

6. Jayaranga H, et al. Utility of urine dipstick in predicting urinary tract infection in pediatric outpatients. J Lab Physicians. 2024:253-259.

7. Sharma S, et al. Diagnostic performance of combined dipstick parameters. J Clin Diagn Res. 2023.

8. Najeeb S, et al. Evaluation of urine dipstick analysis in diagnosis of urinary tract infection. Pak J Med Sci. 2022.

9. Gupta K, et al. Comparative study of urine dipstick and culture in urinary tract infection diagnosis. 2021.

10. Ali M, et al. Diagnostic accuracy of urine dipstick testing. 2020.

11. Lee JH, et al. Evaluation of urine dipstick screening in low-prevalence populations. BMC Infect Dis. 2022.

12. Hunt KM, Green RS, Sartori LF, Aronson PL, Chamberlain JM, Florin TA, et al. Urine Dipstick for the Diagnosis of Urinary Tract Infection in Febrile Infants Aged 2 to 6 Months. Pediatrics. 2025;155(4).

13. Lubell TR, Barasch JM, King B, Ochs JB, Fan W, Duong J, et al. Urinary tract infections in children: Testing a novel, noninvasive, point-of-care diagnostic marker. Acad Emerg Med. 2022;29(3):326-33.

14. Waldecker-Gall S, Waldecker CB, Babel N, Baraliakos X, Seibert F, Westhoff TH. Urinary calprotectin as a diagnostic tool for detecting significant bacteriuria. Sci Rep. 2024;14(1):12230.

15. Iseri E, Jakobsson G, Bertling S, Özenci V, Ekelund O, van der Wijngaart W, et al. Rapid diagnosis of urinary tract infection with miniaturised point-of-care cultivation on a dipstick. Eur J Clin Microbiol Infect Dis. 2025;44(5):1031-40.

16. Boon HA, De Burghgraeve T, Verbakel JY, Van den Bruel A. Point-of-care tests for pediatric urinary tract infections in general practice: a diagnostic accuracy study. Fam Pract. 2022;39(4):616-22.

17. de la Rica-Martinez A, Martínez-Muñoz G, Sanjuan MA, Conesa-Celdrán A, Garcia-Moreno L, Estan-Cerezo G, et al. Low-Cost Electronic Nose for the Determination of Urinary Infections. Sensors (Basel). 2023;24(1).

18. Werter DE, Kazemier BM, van Leeuwen E, de Rotte M, Kuil SD, Pajkrt E, et al. Diagnostic work-up of urinary tract infections in pregnancy: study protocol of a prospective cohort study. BMJ Open. 2022;12(9):e063813.