Urinary Tract Infection: Sensitivity and Specificity

Introduction: An uncomplicated, or lower, UTI is also known as cystitis. The principal symptoms are dysuria, frequency, urgency; hematuria can also be present.

Non-diagnostic historical findings (from Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379) include:

history of backache, fever, feeling unwell, abdominal pain, prior duration, daytime or night-time frequency (number of times), renal angle tenderness, lower abdominal tenderness, previous history of UTI.

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Differential Diagnoses include: Appendicitis, Pyelonephritis

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Women with suspected UTI	62%	Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
	50%
	45%
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The sensitivity and specificity of findings for Urinary Tract Infection are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Urine Culture

95%

85%

>10^2 CFU/ml of E coli. Population: symptomatic women.

Study: N Engl J Med 1982 Aug 19;307(8):463-8. PMID 7099208

Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
Dipstick Nitrite	28%	91%	Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Urine Malodor	24%	90%	Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Hematuria	23%	88%	moderately severe Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Costovertebral Angle Tenderness	21%	88%	Study: JAMA. 2002;287:2701-2710. http://jama.ama-assn.org/cgi/content/full/287/20/2701
Bacteriuria	70%	85%	i.e. microscopically visible bacteria in urine (sensitivity depends a lot on the cutoff number of bacteria) Study: N Engl J Med. 2003 Jul 17;349(3):259-66. PMID 12867610

Sensitive Findings

Finding	Sensitivity	Specificity	Comments, Study
Self-Diagnosis	100%	75%	Study: JAMA. 2002;287:2701-2710. http://jama.ama-assn.org/cgi/content/full/287/20/2701
Pyuria	95%	71%	i.e. microscopic leukocytes Study: N Engl J Med. 2003 Jul 17;349(3):259-66. PMID 12867610
Dipstick Leukocyte Esterase	85%	53%	Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
Dipstick Leukocyte Esterase or Nitrite	75%	82%	Study: N Engl J Med. 2003 Jul 17;349(3):259-66. PMID 12867610
Cloudy Urine	46%	79%	Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Dipstick Nitrite or Dipstick Blood and Leukocyte Esterase	77%	70%	Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Dipstick Protein	47%	69%	Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Nocturia	54%	64%	moderately severe (population is women with suspected UTI) Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Dipstick Blood	73%	54%	Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Urinary Urgency	62%	50%	moderately severe Study: Br J Gen Pract. 2006 Aug;56(529):606-12. PMID 16882379
Flank Pain	55%	50%	Study: JAMA. 2002;287:2701-2710. http://jama.ama-assn.org/cgi/content/full/287/20/2701