Evaluation of Urine Flow Cytometry by an Automated Urine Analyser, as a tool for screening Urinary Tract Infection in the Department of Emergency Medicine

Kannan, S (2020) Evaluation of Urine Flow Cytometry by an Automated Urine Analyser, as a tool for screening Urinary Tract Infection in the Department of Emergency Medicine. Masters thesis, Christian Medical College, Vellore.

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Abstract

INTRODUCTION: Urine is one of the body fluids which is readily available and easy for collection and is alluded to a „virtual renal biopsy‟. Being an inexpensive test, routine urine analysis which includes physical examination, biochemical analysis and microscopic examination of sediment, provides a lot of essential information on the homeostasis and metabolism as well as pathology, if any. Thus it fits into the description of an ideal tool in the preventive medicine and low cost diagnostic test. Urine analysis has remained an age old diagnostic test used by physicians from time immemorial. Urinary tract infection (UTI) is considered the most common bacterial infection and refers to multiplication of a pathogenic micro-organism in the urinary tract, resulting in a wide spectrum of disease manifestations depending on the primary site of infection. UTI has been the cause for extra three million emergency department (ED) visits every year. Patients seeking emergency care are mostly those who fail to meet their primary care physicians at the right time. Hence, it is essential to make the distinction between a complicated case which needs hospitalisation and an uncomplicated infection which can be treated at home. OBJECTIVES: To determine flowcytometric bacteriuria cut-off to diagnose UTI and bacterial class estimation in urine using flow cytometric scattergrams. To create a unified algorithm for UTI screening. METHODS: Prospective cross-sectional study involved collection of urine samples from 339 patients admitted with symptoms of UTI in the Department of Accident and Emergency Medicine between July 2018 to December 2018, of which 304 samples were included in the final analysis by excluding those which did not have flowcytometric scattergrams and counts. Samples run in Sysmex UN 9000 urine analyser were subjected to urine microbiological culture simultaneously. Flowcytometric counts and scattergrams were analysed and compared with microbiological culture results (Gold-standard) using student t test, Man Whitney U test, chi square test, Fishers exact test and ROC curve analysis (bacteriuria cut-off determination). RESULTS: A flow cytometric bacteriuria count of 239/HPF was determined to be the best at 80% sensitivity and 63% specificity from the ROC-curve. Type III pattern in scattergram had a statistically significant association with gram-negative bacterial infection (p<0.001, specificity: 88.40%). Type II pattern was indicative of contaminants (p<0.001, specificity: 91.70%) due to improper collection. We have found that a rapid screening of samples on Sysmex urine analyzer can provide an early and reliable indication of gram-negative UTI providing guidance for the initiation of appropriate antibiotics in the emergency department.

Item Type: Thesis (Masters)
Additional Information: 201713354
Uncontrolled Keywords: Urine Flow Cytometry, Automated Urine Analyser, screening Urinary Tract Infection, Emergency Medicine.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 29 Jan 2021 18:03
Last Modified: 29 Jan 2021 18:03
URI: http://repository-tnmgrmu.ac.in/id/eprint/13432

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