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      Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study

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          Abstract

          Objective

          To assess the test characteristics of a urine dipstick test in predicting a positive urine culture in an outpatient setting in Indonesia.

          Design

          Cross-sectional study.

          Setting

          Two outpatient clinics in Medan, Indonesia.

          Participants

          616 consecutively enrolled participants suspected of having a urinary tract infection.

          Outcome measures

          The primary outcome is the estimates of accuracy (sensitivity, specificity, predictive values) where urine culture is the reference test. The secondary outcome is the post-test probability of a positive urine culture.

          Results

          The optimal test characteristics were obtained when index test positivity was defined as any leucocyte esterase reaction and/or a nitrite reaction and reference test positivity was defined as a urine culture with a growth of at least 10 3 colony-forming units/mL (sensitivity: 88.2% (95% CI 81.6 to 93.1), negative predictive value: 93.0% (95% CI 88.9 to 95.9)). The post-test probability of a positive urine culture after a negative urinary dipstick test was 7% in the obstetric/gynaecology clinic and 8% in the internal medicine clinic.

          Conclusion

          The use of a urine dipstick test in a rule-out strategy can reduce the need for urine culture and avoid the prescription of (ineffective) antibiotics in a non-urology outpatient setting.

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          Most cited references 16

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          Index for rating diagnostic tests

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            Interventions to improve antibiotic prescribing practices for hospital inpatients.

            Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients.
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              The negative impact of antibiotic resistance.

              Antibacterial therapy is one of the most important medical developments of the twentieth century; however, the spread of resistance in healthcare settings and in the community threatens the enormous gains made by the availability of antibiotic therapy. Infections caused by resistant bacteria lead to up to two-fold higher rates of adverse outcomes compared with similar infections caused by susceptible strains. These adverse outcomes may be clinical or economic and reflect primarily the failure or delay of antibiotic treatment. The magnitude of these adverse outcomes will be more pronounced as disease severity, strain virulence, or host vulnerability increases. The negative impacts of antibacterial resistance can be measured at the patient level by increased morbidity and mortality, at the healthcare level by increased resource utilization, higher costs and reduced hospital activity and at the society level by antibiotic treatment guidelines favouring increasingly broad-spectrum empiric therapy. In this review we will discuss the negative impact of antibiotic resistance on patients, the healthcare system and society.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                29 August 2018
                : 8
                : 8
                Affiliations
                [1 ] departmentDepartment of Internal Medicine , Faculty of Medicine, University of Sumatera Utara, H Adam Malik Hospital , Medan, Indonesia
                [2 ] departmentDepartment of Clinical Pathology , Faculty of Medicine Universitas Padjadjaran, Dr Hasan Sadikin General Hospital , Bandung, Indonesia
                [3 ] departmentDepartment of Microbiology , Faculty of Medicine, University of Sumatera Utara, H Adam Malik Hospital , Medan, Indonesia
                [4 ] departmentDepartment of Medical Microbiology , Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
                [5 ] departmentDepartment of Global Health , Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
                [6 ] Amsterdam Institute for Global Health and Development , Amsterdam, The Netherlands
                Author notes
                [Correspondence to ] Dr Frank van Leth; f.c.vanleth@ 123456amc.uva.nl
                Article
                bmjopen-2018-023051
                10.1136/bmjopen-2018-023051
                6119407
                30158234
                © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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                Medicine

                urinary tract infections, dipstick test, accuracy, antimicrobial resistance, indonesia

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