Alfred G. Scottolini

Dipstick chemical urinalysis: an accurate cost-effective screening test.

In a double-blind prospective study of 200 sequential urine specimens the sediment count of leukocytes in the centrifuged urine (white blood cells per high power field) was compared to a chamber count of leukocytes in uncentrifuged urine (white blood cells per microliter.). There was good correlation (coefficient of correlation 0.783, sensitivity 91.9 per cent, specificity 97.6 per cent and efficiency 96.6 per cent) between the more precise chamber count and the more commonly performed sediment count if the methodology of the sediment count was standardized. In a double-blind prospective study the results of the sediment count for leukocytes and erythrocytes were compared to the leukocyte esterase and hemoglobin dipstick results of urine specimens from 1,346 adults who underwent multiphasic screening. The dipsticks were found to be sensitive to physiologic limits for leukocytes and erythrocytes, with only 0.9 per cent false negative results for each. Formed elements in the urine not detectable by dipstick, such as casts and crystals, were present in 3 per cent of the specimens. Among patients who had significant pyuria, hematuria or formed elements not detectable by dipstick chemical urinalysis, no significant pathological condition was detected upon retrospective review. Because the chemical dipstick is not quantitative and because the sensitivity of the dipsticks resulted in many false positive findings compared to the sediment count (red and white blood cells 16.4 and 13.2 per cent, respectively) a protocol is offered in which results of screening urine specimens that are positive on dipstick culture would be confirmed by a properly performed microscopic urinalysis. This protocol as applied to an adult screening population would be an accurate, cost-effective method of urine testing.

Presumptive Identification of Staphylococcus Saprophyticus from Urine Specimens by Colony Appearance and Coagulase Testing: An Evaluation

Two hundred one urine specimens with pure or nearly pure cultures (greater than 5 X 10(4) CFU/mL) of coagulase-negative staphylococcus were identified in reviewing all significant urine isolates over a ten-month period. The majority of these were from young female adult outpatients with Staphylococcus saprophyticus constituting 88.9% of isolates determined with the API Staph-Ident System. For urine specimens, particularly for outpatients, coagulase-negative, nonhemolytic staphylococcal colonies with yellow pigmentation could be identified presumptively as S. saprophyticus with a sensitivity of 97.8% and a specificity of 98.3%, compared with novobiocin susceptibility testing with a sensitivity of 100% and a specificity of 96.9%.