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Benhamza N, Aarab A, Farih S, Saddari A, Yacoubi L, Benaissa E, Ben Lahlou Y, Elouennass M, Maleb A. Prediction of the bacterial shape in urinary tract infections with the Sysmex UF-1000i analyser: technical note. Ann Med Surg (Lond) 2023; 85:4877-4881. [PMID: 37811113 PMCID: PMC10552994 DOI: 10.1097/ms9.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/06/2023] [Indexed: 10/10/2023] Open
Abstract
Background The aim of our study was to explore the utility of the Sysmex UF-1000i analyzer as a rapid screening tool for urinary tract infections (UTI) and its ability to predict bacterial shape in order to help physicians choose the appropriate empiric treatment. Materials and methods This is a retrospective study, including 1023 urine cytobacteriological examinations. Urines were processed according to the recommendations of the medical microbiology reference system (REMIC). Using the Sysmex Uf-1000i analyzer, the authors evaluated bacteria forward scatter (B_FSC) and fluorescent light scatter (B_FLH) in a preliminary discrimination step for UTI caused by bacilli or cocci bacteria. Results The authors got 1023 positive samples. Comparing baccili and cocci bacteria, the authors observed a statistically significant difference for B_FSC but not for B_FLH. The values of B_FLH are very close for the four categories of microorganisms compared (bacilli, cocci, bacilli-cocci association, and yeasts). For these same categories, tests show different values for the B_FSC. A separate analysis of the B_FSC values for bacilli shows that their distribution is relatively homogeneous and exhibits a peak between 20 and 30 ch. Conclusion Dimensional parameters of bacteria generated by UF-1000i could be a rapid and useful tool for predicting the bacterial shape causing UTI.
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Affiliation(s)
| | - Adnane Aarab
- Laboratory of Microbiology, Mohamed VI Teaching Hospital
| | - Soumya Farih
- Laboratory of Microbiology, Mohamed VI Teaching Hospital
| | | | - Loubna Yacoubi
- Laboratory of Microbiology, Mohamed VI Teaching Hospital
| | - Elmostapha Benaissa
- Department of Bacteriology, Mohammed V Teaching Military Hospital
- Epidemiology and Bacterial Resistance Research Team/BIO-INOVA Centre, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Yassine Ben Lahlou
- Department of Bacteriology, Mohammed V Teaching Military Hospital
- Epidemiology and Bacterial Resistance Research Team/BIO-INOVA Centre, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Mostafa Elouennass
- Department of Bacteriology, Mohammed V Teaching Military Hospital
- Epidemiology and Bacterial Resistance Research Team/BIO-INOVA Centre, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Adil Maleb
- Laboratory of Microbiology, Mohamed VI Teaching Hospital
- Research team ‘Cell Biology and Pharmacology Applied to Health Sciences’, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda
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Wang H, Han FF, Wen JX, Yan Z, Han YQ, Hu ZD, Zheng WQ. Accuracy of the Sysmex UF-5000 analyzer for urinary tract infection screening and pathogen classification. PLoS One 2023; 18:e0281118. [PMID: 36724192 PMCID: PMC9891513 DOI: 10.1371/journal.pone.0281118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 01/15/2023] [Indexed: 02/02/2023] Open
Abstract
The screening performance of urine flow cytometry parameters (e.g., white blood cell and bacteria) for urinary tract infection (UTI) has been widely recognized. The majority of previous studies, however, investigated the screening performance of Sysmex UF-1000i urine flow cytometer. This study aimed to investigate the screening performance of Sysmex UF-5000 analyzer, a third-generation urinary flow cytometer, for UTI and its novel parameter named Gram flag for discriminating gram-positive and negative pathogens. Urine specimens sent to the clinical microbiology laboratory of our hospital for bacterial culture between September 13, 2021, and November 15, 2021, were prospectively and consecutively collected. The Sysmex UF-5000 analyzer was used to determine urine white blood cell (WBC) and bacteria simultaneously. A chemical strip was used to assess urine nitrate. UTI was defined as positive urine bacterial culture > 104 CFU /ml. The receiver operating characteristics (ROC) curve, nomogram, decision tree, and decision curve were used to determine the screening performance of urine WBC, nitrate, and bacterial. A total of 246 UTIs and 425 non-UTIs were enrolled. The areas under the ROC curve (AUCs) for WBC and bacterial were 0.74 and 0.86, respectively. The decision curve showed that urine bacteria had a higher benefit than WBC. The nomogram indicated that urine bacterial had the largest effect on the probability of UTI. The sensitivity and specificity of the decision tree were 0.69 and 0.95, respectively. The flag of Gram-negative had a positive predictive value (PPV) of 0.93 in patients with urine bacteria > 1367 /μl. Therefore, we conclude that urine bacteria determined by the Sysmex UF-5000 had higher screening performance and greater benefit than WBC. The decision tree can be used to improve the screening performance of routine urinary parameters. The flag of Gram-negative is a reliable indicator to confirm gram-negative bacteria infection in UTI patients.
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Affiliation(s)
- Hua Wang
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Parasitology, The School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Fei-Fei Han
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jian-Xun Wen
- Department of Medical Experiment Center, The School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Zhi Yan
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Parasitology, The School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Yan-Qiu Han
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- * E-mail: (WQZ); (ZDH)
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Parasitology, The School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
- * E-mail: (WQZ); (ZDH)
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Falahkheirkhah K, Guo T, Hwang M, Tamboli P, Wood CG, Karam JA, Sircar K, Bhargava R. A generative adversarial approach to facilitate archival-quality histopathologic diagnoses from frozen tissue sections. J Transl Med 2022; 102:554-559. [PMID: 34963688 PMCID: PMC9050807 DOI: 10.1038/s41374-021-00718-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 01/16/2023] Open
Abstract
In clinical diagnostics and research involving histopathology, formalin-fixed paraffin-embedded (FFPE) tissue is almost universally favored for its superb image quality. However, tissue processing time (>24 h) can slow decision-making. In contrast, fresh frozen (FF) processing (<1 h) can yield rapid information but diagnostic accuracy is suboptimal due to lack of clearing, morphologic deformation and more frequent artifacts. Here, we bridge this gap using artificial intelligence. We synthesize FFPE-like images ("virtual FFPE") from FF images using a generative adversarial network (GAN) from 98 paired kidney samples derived from 40 patients. Five board-certified pathologists evaluated the results in a blinded test. Image quality of the virtual FFPE data was assessed to be high and showed a close resemblance to real FFPE images. Clinical assessments of disease on the virtual FFPE images showed a higher inter-observer agreement compared to FF images. The nearly instantaneously generated virtual FFPE images can not only reduce time to information but can facilitate more precise diagnosis from routine FF images without extraneous costs and effort.
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Affiliation(s)
- Kianoush Falahkheirkhah
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana- Champaign, Urbana, IL 61801,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana- Champaign, Urbana, IL 61801
| | - Tao Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Hwang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Pheroze Tamboli
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher G Wood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose A Karam
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX,Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanishka Sircar
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX,Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rohit Bhargava
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA. .,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA. .,Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA. .,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA. .,Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA. .,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
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Ortiz de la Tabla V, Gázquez G, Infante A, Martin C, Buñuel F, Gutiérrez F. Performance of the cobas u 701 Analyzer in Urinary Tract Infection Screening. Ann Lab Med 2019; 39:464-469. [PMID: 31037865 PMCID: PMC6502947 DOI: 10.3343/alm.2019.39.5.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 11/24/2022] Open
Abstract
Background Negative urine cultures to rule out urinary tract infections (UTI) generate a considerable laboratory workload; thus, a rapid screening test is desirable. We evaluated the performance of a new automated microscopy analyzer, cobas u 701 (Roche Diagnostics International, Rotkreuz, Switzerland) for the screening of UTI, and developed a rule-out strategy to reduce the number of samples requiring culture. We also assessed squamous epithelial cell (SEC) count as a predictor of culture contamination. Methods In total, 1,604 urine samples from outpatients were analyzed with cobas u 701 and culture. Bacterial (BAC) and white blood cell (WBC) counts were used for sample interpretation. To determine a useful cut-off point to predict negative cultures, we selected the highest sensitivity and specificity values obtained from ROC curves. Diagnostic accuracy by age and gender was evaluated. Results Urine culture showed growth of ≥104 colony forming units (CFU)/mL in 256 samples (16.0%). The highest sensitivity (91.8%) and specificity (68.4%) were obtained for cut-off points of 119 BAC/µL and 22 WBC/µL. The combination of BAC and WBC improved the performance of the rule-out strategy with a low rate of false-negative results (1.5%) and a high negative predictive value (NPV, 97.3%). Fifty-seven percent of the samples would not have required culture. SEC count was a poor predictor of culture contamination. Conclusions cobas u 701 can substantially reduce the number of urine samples requiring culture, with a low false-negative rate and a high NPV.
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Affiliation(s)
| | - Gregoria Gázquez
- Microbiology Service, Hospital Universitario de San Juan, Alicante, Spain
| | - Ana Infante
- Microbiology Service, Hospital Universitario de San Juan, Alicante, Spain
| | - Coral Martin
- Microbiology Service, Hospital Universitario de San Juan, Alicante, Spain
| | - Fernando Buñuel
- Microbiology Service, Hospital Universitario de San Juan, Alicante, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain.,Department of Clinical Medicine, University Miguel Hernández, Alicante, Spain
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The development and validation of different decision-making tools to predict urine culture growth out of urine flow cytometry parameter. PLoS One 2018; 13:e0193255. [PMID: 29474463 PMCID: PMC5825091 DOI: 10.1371/journal.pone.0193255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Patients presenting with suspected urinary tract infection are common in every day emergency practice. Urine flow cytometry has replaced microscopic urine evaluation in many emergency departments, but interpretation of the results remains challenging. The aim of this study was to develop and validate tools that predict urine culture growth out of urine flow cytometry parameter. Methods This retrospective study included all adult patients that presented in a large emergency department between January and July 2017 with a suspected urinary tract infection and had a urine flow cytometry as well as a urine culture obtained. The objective was to identify urine flow cytometry parameters that reliably predict urine culture growth and mixed flora growth. The data set was split into a training (70%) and a validation set (30%) and different decision-making approaches were developed and validated. Results Relevant urine culture growth (respectively mixed flora growth) was found in 40.2% (7.2% respectively) of the 613 patients included. The number of leukocytes and bacteria in flow cytometry were highly associated with urine culture growth, but mixed flora growth could not be sufficiently predicted from the urine flow cytometry parameters. A decision tree, predictive value figures, a nomogram, and a cut-off table to predict urine culture growth from bacteria and leukocyte count were developed, validated and compared. Conclusions Urine flow cytometry parameters are insufficient to predict mixed flora growth. However, the prediction of urine culture growth based on bacteria and leukocyte count is highly accurate and the developed tools should be used as part of the decision-making process of ordering a urine culture or starting an antibiotic therapy if a urogenital infection is suspected.
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Bignardi GE. Validation and verification of automated urine particle analysers. J Clin Pathol 2016; 70:94-101. [PMID: 27802413 DOI: 10.1136/jclinpath-2016-203958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/26/2016] [Accepted: 10/04/2016] [Indexed: 11/03/2022]
Abstract
There is often uncertainty on how validation and verification of newly introduced tests should be conducted, and there is a real risk of verification becoming a meaningless ritual, rather than a useful exercise. This article reviews the literature and makes recommendations regarding the validation and verification of automated urine particles analysers. A generic practical approach to verification is also recommended. For many analysers, the accuracy of white blood cells, epithelial cells and bacterial counts is corroborated by a number of independent evaluations; thus, any verification laboratory work could be significantly scaled down. Conversely, in the scenario that automated urine microscopy is used as a screening test to reduce the number of urines cultured, the extremely variable performance reported in the literature requires a full-scale verification to define the optimal cut-off values that give a sensitivity of >98% with the local settings and circumstances. With some analysers, the risk of carry-over also needs to be assessed, as part of the verification process, and exclusion criteria (urines requiring culture regardless of the microscopy results) need to be well defined, as there are patients or specimen types for which the performance of microscopy as a screening test may not be adequate.
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Paattiniemi EL, Karumaa S, Viita AM, Kärpänoja P, Mäkelä M, Isojärvi J, Sarkkinen H. Analysis of the costs for the laboratory of flow cytometry screening of urine samples before culture. Infect Dis (Lond) 2016; 49:217-222. [PMID: 27766919 DOI: 10.1080/23744235.2016.1239028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Urine culture samples comprise a large proportion of the workload in clinical microbiology laboratories, and most of the urine samples show no growth or insignificant growth. A flow cytometry-based analyzer (Sysmex Corporation, Japan) has been used to screen out negative urine samples prior to culture in the Päijät-Häme district. We applied decision analytic modelling to analyze, from a laboratory perspective, the economic feasibility of the screening method as compared to culture only (conventional method) for diagnosis of urinary tract infection. Our model suggests that the least costly analytical strategy is the conventional method. The incremental cost of screening is €0.29/sample. Although laboratory costs are higher, considerable savings on workload can be achieved. Furthermore, screening has numerous benefits on the treatment process of a patient that well warrant the use of the screening method. We conclude that the incremental cost of screening the samples is worth the expense.
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Affiliation(s)
- Eeva-Liisa Paattiniemi
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
| | - Santra Karumaa
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
| | | | - Pauliina Kärpänoja
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
| | - Marjukka Mäkelä
- c National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Jaana Isojärvi
- c National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Hannu Sarkkinen
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
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Accuracy of Automated Flow Cytometry-Based Leukocyte Counts To Rule Out Urinary Tract Infection in Febrile Children: a Prospective Cross-Sectional Study. J Clin Microbiol 2016; 54:2975-2981. [PMID: 27682127 DOI: 10.1128/jcm.01382-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/16/2016] [Indexed: 11/20/2022] Open
Abstract
Automated flow cytometry of urine remains an incompletely validated method to rule out urinary tract infection (UTI) in children. This cross-sectional analytical study was performed to compare the predictive values of flow cytometry and a dipstick test as initial diagnostic tests for UTI in febrile children and prospectively included 1,106 children (1,247 episodes). Urine culture was used as the gold standard test for diagnosing UTI. The performance of screening tests to diagnose UTI were established using receiver operating characteristic (ROC) analysis. Among these 1,247 febrile episodes, 221 UTIs were diagnosed (17.7% [95% confidence interval {CI}, 15.6 to 19.8%]). The area under the ROC curve for flow cytometry white blood cell (WBC) counts (0.99 [95% CI, 0.98 to 0.99]) was significantly superior to that for red blood cell (0.74 [95% CI, 0.70 to 0.78]) and bacterial counts (0.89 [95% CI, 0.87 to 0.92]) (P < 0.001). Urinary WBC counts also had a significantly higher area under the ROC curve than that of the leukocyte esterase (LE) dipstick (0.92 [95% CI, 0.90 to 0.94]), nitrite dipstick (0.83 [95% CI, 0.80 to 0.87]), or the combination of positive LE and/or nitrite dipstick (0.91 [95% CI, 0.89 to 0.93]) test (P < 0.001). The presence of ≥35 WBC/μl of urine was the best cutoff point, yielding both a high sensitivity (99.5% [95% CI, 99 to 100%]) and an acceptable specificity (80.6% [95% CI, 78 to 83%]). Using this cutoff point would have reduced the number of samples sent to the laboratory for culture by 67%. In conclusion, the determination of urinary WBC counts by flow cytometry provides optimal performance as an initial diagnostic test for UTI in febrile children.
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Dolscheid-Pommerich RC, Klarmann-Schulz U, Conrad R, Stoffel-Wagner B, Zur B. Evaluation of the appropriate time period between sampling and analyzing for automated urinalysis. Biochem Med (Zagreb) 2016; 26:82-9. [PMID: 26981022 PMCID: PMC4783094 DOI: 10.11613/bm.2016.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/27/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Preanalytical specifications for urinalysis must be strictly adhered to avoid false interpretations. Aim of the present study is to examine whether the preanalytical factor ‘time point of analysis’ significantly influences stability of urine samples for urine particle and dipstick analysis. Materials and methods In 321 pathological spontaneous urine samples, urine dipstick (Urisys™2400, Combur-10-Test™strips, Roche Diagnostics, Mannheim, Germany) and particle analysis (UF-1000 i™, Sysmex, Norderstedt, Germany) were performed within 90 min, 120 min and 240 min after urine collection. Results For urine particle analysis, a significant increase in conductivity (120 vs. 90 min: P < 0.001, 240 vs. 90 min: P < 0.001) and a significant decrease in WBC (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), RBC (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), casts (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001) and epithelial cells (120 vs. 90 min P = 0.610, 240 vs. 90 min P = 0.041) were found. There were no significant changes for bacteria. Regarding urine dipstick analysis, misclassification rates between measurements were significant for pH (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), leukocytes (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), nitrite (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), protein (120 vs. 90 min P < 0.001, 240 vs. 90 min P<0.001), ketone (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), blood (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), specific gravity (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001) and urobilinogen (120 vs. 90 min, P = 0.031). Misclassification rates were not significant for glucose and bilirubin. Conclusion Most parameters critically depend on the time window between sampling and analysis. Our study stresses the importance of adherence to early time points in urinalysis (within 90 min).
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Affiliation(s)
| | - Ute Klarmann-Schulz
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany; Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Birgit Stoffel-Wagner
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Berndt Zur
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
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Kocer D, Sarıguzel FM, Karakukcu C. Cutoff values for bacteria and leukocytes for urine sediment analyzer FUS200 in culture-positive urinary-tract infections. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:414-7. [DOI: 10.3109/00365513.2014.900189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shang YJ, Wang QQ, Zhang JR, Xu YL, Zhang WW, Chen Y, Gu ML, Hu ZD, Deng AM. Systematic review and meta-analysis of flow cytometry in urinary tract infection screening. Clin Chim Acta 2013; 424:90-5. [DOI: 10.1016/j.cca.2013.05.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
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Martinez MHM, Bottini PV, Levy CE, Garlipp CR. UriSed as a screening tool for presumptive diagnosis of urinary tract infection. Clin Chim Acta 2013; 425:77-9. [PMID: 23906796 DOI: 10.1016/j.cca.2013.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although a quantitative urine culture is essential for the final diagnosis of urinary tract infection, it is time-consuming and an expensive procedure. Effective screening tests would be a promising alternative to provide immediate results for the clinician and eliminate unnecessary culturing for most of the negative samples. The aim of this study was to evaluate the performance of an automated sediment analyzer (UriSed) as screening tool for presumptive diagnosis of urinary tract infection. METHODS We studied 1379 fresh midstream clean-catch urine samples from children to elderly. All samples were submitted to automated sediment analysis (UriSed) and quantitative urine culture (CLED medium agar). RESULTS The sediment analyzer detected leukocyturia and/or significant bacteriuria with sensitivity of 97%, specificity of 59%, positive predictive value of 27%, negative predictive value of 99%, and accuracy of 64% at cutoff values of bacteria count ≥12.6 elements/hpf and WBC ≥6 cells/hpf. These data suggest a potential 52% reduction of unnecessary urine cultures. CONCLUSION The UriSed seems to be an efficient tool for screening UTI with high sensitivity and low rate of false-negative results.
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Affiliation(s)
- M H M Martinez
- Division of Clinical Pathology, University of Campinas/UNICAMP, Campinas, SP, Brazil
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13
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de Frutos-Serna M, Asensio-Calle ML, Haro-Pérez AM, Blázquez-de Castro AM, Gutiérrez-Zufiaurre MN, Iglesias-García J. [Evaluation of the Sysmex UF-1000i flow cytometer for screening of urinary tract infection]. Enferm Infecc Microbiol Clin 2013; 32:147-51. [PMID: 23642284 DOI: 10.1016/j.eimc.2013.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/15/2013] [Accepted: 02/19/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The urine culture is a huge workload in the Microbiology Laboratory and remains the gold standard for the diagnosis of urinary tract infections. Considering the high prevalence of negative results, the implementation of a reliable screening method could lead to cost saving in the workload, and speed up reporting of negative results. METHODS We evaluated the usefulness of the flow cytometer UF-1000i in the screening for negative samples than could be excluded from culture. We divided the samples into two groups, Group 1, males and women of childbearing age who were considered positive with a growth ≥ 104 CFU/ml, and Group 2, considered positive with ≥ 105 CFU/ml growth. RESULTS On comparing the culture and screening data in the ROC curve, the best sensitivity and specificity points were 53.1 bact/μl for Group 1, and 128.3 bact/μl for Group 2. In Group 1, the sensitivity was 92.2% and a specificity of 60%, a reduction in urine cultures of 46%, with 2.1% false negative (42 samples). In Group 2, the sensitivity was 86%, with a specificity of 87.7%, a culture reduction of 57.5%, and 5.1% false negatives (74 samples). CONCLUSION The incorporating of the UF-1000i cytometer to the screening of urine samples depends on the characteristics of the patients and the definition of positive urine culture. In our case, with only studying bacteriuria, the data on the reduction of workload and the false negatives seriously question this incorporation.
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Affiliation(s)
| | | | - Ana María Haro-Pérez
- Servicio de Medicina Preventiva, Hospital Universitario de Salamanca, Salamanca, España
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O'Neil E, Burton S, Horney B, MacKenzie A. Comparison of white and red blood cell estimates in urine sediment with hemocytometer and automated counts in dogs and cats. Vet Clin Pathol 2012. [DOI: 10.1111/vcp.12004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elizabeth O'Neil
- Department of Pathology & Microbiology; Atlantic Veterinary College; University of Prince Edward Island; Charlottetown; PE; Canada
| | - Shelley Burton
- Department of Pathology & Microbiology; Atlantic Veterinary College; University of Prince Edward Island; Charlottetown; PE; Canada
| | - Barbara Horney
- Department of Pathology & Microbiology; Atlantic Veterinary College; University of Prince Edward Island; Charlottetown; PE; Canada
| | - Allan MacKenzie
- Department of Pathology & Microbiology; Atlantic Veterinary College; University of Prince Edward Island; Charlottetown; PE; Canada
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A Critical Appraisal of the Role of the Clinical Microbiology Laboratory in the Diagnosis of Urinary Tract Infections. J Clin Microbiol 2011. [DOI: 10.1128/jcm.00788-11] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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16
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Screening for urinary tract infection with the Sysmex UF-1000i urine flow cytometer. J Clin Microbiol 2011; 49:1025-9. [PMID: 21248088 DOI: 10.1128/jcm.01669-10] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of urinary tract infection (UTI) by urine culture is time-consuming and can produce up to 60 to 80% negative results. Fast screening methods that can reduce the necessity for urine cultures will have a large impact on overall turnaround time and laboratory economics. We have evaluated the detection of bacteria and leukocytes by a new urine analyzer, the UF-1000i, to identify negative urine samples that can be excluded from urine culture. In total, 1,577 urine samples were analyzed and compared to urine culture. Urine culture showed growth of ≥10(3) CFU/ml in 939 samples (60%). Receiver operating characteristics (ROC) curves and ROC decision plots were been prepared at three different gold standard definitions of a negative urine culture: no growth, growth of bacteria at <10(4) CFU/ml, and growth of bacteria at <10(5) CFU/ml. Also, the reduction in urine cultures and the percentage of false negatives were calculated. At the most stringent gold standard definition of no growth, a chosen sensitivity of 95% resulted in a cutoff value of 26 bacteria/μl, a specificity of 43% and a reduction in urine cultures of only 20%, of which 14% were false negatives. However, at a gold standard definition of <10(5) CFU/ml and a sensitivity of 95%, the UF-1000i cutoff value was 230 bacteria/μl, the specificity was 80%, and the reduction in urine cultures was 52%, of which 0.3% were false negatives. The applicability of the UF-1000i to screen for negative urine samples strongly depends on population characteristics and the definition of a negative urine culture. In our setting, however, the low workload savings and the high percentage of false-negative results do not warrant the UF-1000i to be used as a screening analyzer.
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Case–control time course study of urinary leukocyte and bacterial counts in patients with acute urinary tract infections responsive and not responsive to antibacterial therapy. Clin Chim Acta 2010; 411:1371-4. [DOI: 10.1016/j.cca.2010.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 05/14/2010] [Accepted: 05/14/2010] [Indexed: 11/16/2022]
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De Rosa R, Grosso S, Bruschetta G, Avolio M, Stano P, Modolo ML, Camporese A. Evaluation of the Sysmex UF1000i flow cytometer for ruling out bacterial urinary tract infection. Clin Chim Acta 2010; 411:1137-42. [DOI: 10.1016/j.cca.2010.03.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 03/22/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
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Screening of urine samples by flow cytometry reduces the need for culture. J Clin Microbiol 2010; 48:3117-21. [PMID: 20592157 DOI: 10.1128/jcm.00617-10] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Urine samples constitute a large proportion of samples tested in clinical microbiology laboratories. Culturing of the samples is fairly time- and labor-consuming, and most of the samples will yield no growth or insignificant growth. We analyzed the feasibility of the flow cytometry-based UF-500i instrument (Sysmex, Japan) to screen out urine samples with no growth or insignificant growth and reduce the number of samples to be cultured. A total of 1,094 urine specimens sent to our laboratory for culture during 4 months in the spring of 2009 in Lahti, Finland, were included in the study. After culture, all samples were analyzed with the Sysmex UF-500i for bacterial and leukocyte (white blood cell [WBC]) counts. Youden index and closest (0,1) methods were used to determine the cutoff values for bacterial and WBC counts in culture-positive and -negative groups. By flow cytometry, samples considered positive for UTI in culture had bacterial and WBC values that were significantly higher than those for samples considered negative. The flow cytometric screening worked best when both bacterial counts and WBC counts were used with age- and gender-specific cutoff values for all patient groups, excluding patients with urological disease or anomaly. By use of these cutoff values, 5/167 (3.0%) of culture-positive samples were missed by UF-500i and the percentage of samples that did not need to be cultured was 64.5%. Use of the UF-500i instrument is a reliable method for screening out a major part of the UTI-negative samples, significantly diminishing the amount of work required in the microbiology laboratory.
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Hu X, Zhang J, Zhang X. Evaluation of the Sysmex UF-1000i Urine Analyzer as a Screening Test to Reduce the Need for Urine Cultures for Urinary Tract Infection. Lab Med 2010. [DOI: 10.1309/lm9p7lk3haseoskd] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Brilha S, Proença H, Cristino JM, Hänscheid T. Use of flow cytometry (Sysmex® UF-100) to screen for positive urine cultures: in search for the ideal cut-off. Clin Chem Lab Med 2010; 48:289-92. [DOI: 10.1515/cclm.2010.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Manoni F, Fornasiero L, Ercolin M, Tinello A, Ferrian M, Hoffer P, Valverde S, Gessoni G. Cutoff values for bacteria and leukocytes for urine flow cytometer Sysmex UF-1000i in urinary tract infections. Diagn Microbiol Infect Dis 2009; 65:103-7. [DOI: 10.1016/j.diagmicrobio.2009.06.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/27/2009] [Accepted: 06/03/2009] [Indexed: 11/25/2022]
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Shike H, Kanegaye JT, Best BM, Pancheri J, Burns JC. Pyuria associated with acute Kawasaki disease and fever from other causes. Pediatr Infect Dis J 2009; 28:440-3. [PMID: 19319019 PMCID: PMC2738928 DOI: 10.1097/inf.0b013e318193ec8e] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite the widespread recognition of pyuria in acute Kawasaki disease (KD) patients and its inclusion in the American Heart Association list of supporting laboratory data for KD diagnosis, no systematic study of pyuria and the origin of these cells in KD patients have been reported. We used automated urinalysis with flow cytometry to characterize urine samples from 135 acute KD subjects and 87 febrile control (FC) subjects without urinary tract infection. Pyuria [defined as > or =12 (for males) or 20 (for females) cells/microL] was present in 79.8% of KD and 54.0% of FC subjects (P < 0.0001). The median number of white blood cells (WBC) in the urine was 42 WBC/microL in KD and 12 WBC/microL in FC (P < 0.0001). No significant difference between the groups was seen for urine red blood cell (RBC) count, protein, or specific gravity. Comparison of voided versus catheter-collected urine samples indicated an origin of the cells from the bladder or upper urinary tract in both patient groups. Pyuria in KD subjects was not correlated with age or day of illness. Overall, the presence of pyuria was neither specific nor sensitive as a marker for KD, but the magnitude of pyuria was significantly higher in KD patients compared with the FC group.
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Affiliation(s)
- Hiroko Shike
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA
| | - John T. Kanegaye
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA,Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, CA
| | - Brookie M. Best
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA
| | - Joan Pancheri
- Division of Clinical Research, Rady Children’s Hospital San Diego, San Diego, CA
| | - Jane C. Burns
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA
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Kim SY, Kim YJ, Lee SM, Hwang SH, Kim HH, Son HC, Lee EY. Evaluation of the Sysmex UF-100 urine cell analyzer as a screening test to reduce the need for urine cultures for community-acquired urinary tract infection. Am J Clin Pathol 2007; 128:922-5. [PMID: 18024316 DOI: 10.1309/4606ec29u50dvafy] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We evaluated the UF-100 flow cytometer (TOA Medical Electronics, Kobe, Japan) as a screening test for community-acquired urinary tract infection (UTI) to reduce the need for bacterial cultures. By comparing the test results for 330 urine samples with quantitative urine cultures, we established cutoff criteria for the UF-100. To rule out hospital-acquired UTI, all urine samples were from new patients who had not been admitted to a hospital within the previous month. Abacterial cutoff value of 3,000/microL provided the best discrimination for community-acquired UTI, with a sensitivity of 94.4% and a specificity of 73.4%compared with urine culture. It was possible to forgo 58.2% of cultures with only 4 false-negative results. With a bacterial cutoff value of 1,500/microL, the sensitivity improved to 100%, but the specificity declined to 49.8%, and only 38.5% of cultures could be avoided without any false-negative results. Screening with the UF-100 for community-acquired UTI is acceptable for routine use. It would improve the efficiency of the routine microbiology laboratory, and unnecessary antibiotic prescriptions could be reduced.
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