Evaluation of Leukocyte Esterase Dipstick Test as a Surrogate Marker for Urinary Tract Infection: A Prospective Analytical Observational Study in a Tertiary Care Teaching Hospital

Background and aims: Urinary tract infection (UTI) is recognized by demonstrating the presence of multiplying pathogens in urine in the presence of symptoms.They present with varied clinical symptoms, including fever with chills, dysuria, frequency, suprapubic pain, hematuria, and pyuria, among others.Culture reports require about 48 hours to validate UTI.This creates a lacuna and limitation in accurately diagnosing UTI and initiating prompt therapy, with the temptation to resort to empirical therapy being imposed upon the surgeon in the line of intent to treat.Due to procedure-imposed time limitations with urine culture reports in resource-limited settings, with uncertainty in future patient follow-up, the urine dipstick test is commonly used as a substitute, which forms the basis of the current study.Patients and methods: A prospective observational analytical study was conducted from September 2022 to February 2024 on 100 patients attending the surgical OPD in a tertiary care medical college teaching hospital of Delhi.After obtaining informed consent and local IEC approval, eligible patients were enrolled into this study to assess the severity of their urinary symptoms using the urinary tract infection symptoms assessment (UTISA) questionnaire, with urine samples sent for routine and culture analysis, along with spot urine leukocyte esterase dipstick test (LEDT).Results: Comparative evaluation of results revealed that LEDT had an overall sensitivity of 100% and a specificity of 74.1% in predicting UTI, otherwise detected on urine routine/microscopy, with an impressive diagnostic accuracy of nearly 93%. Conclusion:Positive urine LEDT was demonstrated to be highly sensitive and quite specific in correctly predicting proven UTI, and the same can be confidently used to initiate empirical therapy as a viable quick substitute to urine culture in resource-limited settings amongst select patients with uncertain compliance and incomplete follow-up.