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

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.