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. 2013 Apr 5;26(8):550–553. [Article in Spanish] doi: 10.1016/S0212-6567(00)78720-8

¿Es útil la disuria para el diagnóstico de la infección del tracto urinario?

Is dysuria useful for the diagnosis of urinary tract infections?

R Martín Álvarez a, J Martín Fernández b,*, C Lobón Agúndez a, T Hernando López c, AE Crespo Garzón d, G Sabugal Rodelgo e
PMCID: PMC7679603  PMID: 11149188

Abstract

Objective

To assess the validity of criterion and predictive value of dysuria for the diagnosis of UTI.

Design

Cross-sectional study to assess a symptom.

Setting

Six general medicine clinics (four urban clinics and two rural clinics) in the 11th Health Area in Madrid.

Patients

The sample consists of 232 patients aged above fourteen who consulted during six consecutive months (116 of them reported having dysuria and 116 were asymptomatic).

Measurements and main results

The diagnosis of urinary tract infections (UTI) was achieved through positive urine cultures or bacteriuria and leukocyturia in the centrifuged urine sediment. The sensitivity (S) of dysuria analysis for the diagnosis of UTI, its specifity (E), its predictive value (VP), and its probability coeficient (CP) were considered. Average age of the sample was 54 years old (range 19–82); 73% of the patients were female. No statistically significative difference of sex and age was found between cases and non-cases (p > 0.1). Dysuria showed a 96% of sensitivity (95% CI, 86–98%), a 69% of E (95% CI, 61–76%) and 3.1 of CPP (95% CI, 2.7–3.5) for UTI diagnosis. In the women subgroup there was 95% of sensitivity (95% CI, 84–99%) and 67% of E (95% CI, 58–75%). A positive predictive value of 30% (95% CI, 22–40) and a negative predictive value of 99% (95% CI, 95–100) were estimated for this symptom.

Conclusions

The diagnosis of urinary tract infections is unlikely in the absence of dysuria, but to treat all dysuria patients as UTI entails a high rate of overtreatment.

Bibliografía

  • 1.Branch W. Urinary tract infections. In: Branch W.B., editor. Office practice of medicine. 3.a. Saunder; Filadelfia:: 1994. pp. 377–387. [Google Scholar]
  • 2.Schleupner C.J. Urinary tract infections. Separiting the genders and the ages. Postgrad Med. 1997;101:231–237. doi: 10.3810/pgm.1997.06.232. [DOI] [PubMed] [Google Scholar]
  • 3.Kunin C.M. Urinary tract infections in females. Clin Infect Dis. 1994;18:1–12. doi: 10.1093/clinids/18.1.1. [DOI] [PubMed] [Google Scholar]
  • 4.Ward T., Jones S.T. Infecciones del tracto urinario. In: Reese R., editor. Un planteamiento práctico de las enfermedades infecciosas. 3.a. MSD; Madrid:: 1991. pp. 393–427. [Google Scholar]
  • 5.Hernández A., Olivier C., Reyes M., Carballido J. Infecciones urinarias inespecíficas. Formas clínicas. Medicine. 1998;63:2935–2943. [Google Scholar]
  • 6.Johnson C.C. Definiciones, clasificación y cuadro clínico inicial de las infecciones urinarias. Clin Med North Am (ed. esp.) 1991;2:243–255. [Google Scholar]
  • 7.Buitrago F., Turabián J.L. Problemas nefrourológicos. Infección urinaria. In: Martín Zurro A., Cano Pérez J.F., editors. Manual de atención primaria. 3.a. Doyma; Barcelona:: 1994. pp. 848–851. [Google Scholar]
  • 8.Bastida M.T., Martínez J.A., López P., Ribera L., Expósito M. Infección urinaria bacteriémica en el varón. Estudio comparativo frente a la pielonefritis bacteriémica femenina. Med Clin (Barc) 1997;109:321–323. [PubMed] [Google Scholar]
  • 9.Leaños A., Contreras I., Canales R., Villagómez E., Cervantes I. Rendimiento diagnóstico de algunas pruebas en orina en las infecciones de vías urinarias. Rev Invest Clin. 1996;48:117–123. [PubMed] [Google Scholar]
  • 10.Pallares J., Casas J., Guarga J., Marquet R., Grifell E., Juvé R. Métodos de diagnóstico rápido como predictores de infección urinaria en atención primaria. Med Clin (Barc) 1988;91:775–778. [PubMed] [Google Scholar]
  • 11.Kass E.H. Asymptomatic infections for the urinary tract. Trans Assoc Am Physicians. 1956;69:56–61. [PubMed] [Google Scholar]
  • 12.Jenkins R.D., Fenn J.P., Matsen J.M. Review of urine microscopy for bacteriuria. JAMA. 1986;255:3397–3403. [PubMed] [Google Scholar]
  • 13.Stamm W.E., Counts G.W., Running K.R., Fihn S., Turck M., Holmes K.K. Diagnosis of coliform infections in acutely dysuria women. N Engl J Med. 1982;307:463. doi: 10.1056/NEJM198208193070802. [DOI] [PubMed] [Google Scholar]
  • 14.Lipscky B.A., Ireton R.C., Fihn S.D., Hackett R., Berger R.E. Diagnosis of bacteriuria in men: specimen collection and culture interpretation. J Infect Dis. 1987;155:847–854. doi: 10.1093/infdis/155.5.847. [DOI] [PubMed] [Google Scholar]
  • 15.Stamm W.E., Hooton T.M. Management of urinary tract infection in adults. N Engl J Med. 1993;329:1328–1343. doi: 10.1056/NEJM199310283291808. [DOI] [PubMed] [Google Scholar]
  • 16.Berg A.O. Variations among family physicians’ management strategies for lower urinary tract infectionin women: a report from the Washington Family Physicians Collaborative Research Network. J Am Board Fam Pract. 1991;4:327–330. [PubMed] [Google Scholar]
  • 17.Barry H.C., Ebell M.H., Hickner J. Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Fam Pract. 1997;44:49–60. [PubMed] [Google Scholar]
  • 18.Jou W.W., Powers R.D. Utility of dipstick urinalysis as a guide to managementof a patient with suspected infection or hematuria. South Med J. 1998;91:266–269. doi: 10.1097/00007611-199803000-00010. [DOI] [PubMed] [Google Scholar]
  • 19.Argimón Pallas J.M., Jiménez Villa J. 2.a. Harcourt; Barcelona:: 1999. Métodos de investigación clínica y epidemiológica. [Google Scholar]
  • 20.Gómez J., Ausejo M., Acuña R., Sáez M., Rodríguez C., Díaz F. Tratamiento farmacológico de las infecciones urinarias en adultos. Hoja de Evaluación terapéutica de la Comisión de Farmacia y Terapéutica Área 11 INSALUD. Madrid, agosto. 1995;73 [Google Scholar]
  • 21.Alberquilla A., Arce A., García de Codes A., González Rodríguez-Salinas C., Pilas Pérez M., Rivera Guzmán J.M. Morbilidad. Boletín de indicadores SISA 11. Área 11 del Insalud. Madrid, mayo. 1995;4 [Google Scholar]
  • 22.Johnson J.R., Stamm W.E. Urinary tract infection in women: diagnosis and treatment. Ann Intern Med. 1989;111:906–917. doi: 10.7326/0003-4819-111-11-906. [DOI] [PubMed] [Google Scholar]

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