Background
Methods
Search strategy
Study selection
Data extraction
Quality assessment
Data synthesis and analysis
Summary estimates across different reference standards
Bayesian analysis and near patient testing (dipstick)
Results
Search Strategy
Characteristics of included studies
Study | Inclusion criteria | No. of patients | Mean age, y (range) | Incidence of UTI% | Reference Test | Setting and country |
---|---|---|---|---|---|---|
McIsaac 2002 | Women ≥ 16 y presenting with symptoms of UTI | N =231 | M = 43.9 (20-92) | 53.2% | ≥ 102 CFU/ml | 4 urban academic family medicine clinics in Canada |
McIsaac 2007 | Women ≥ 16 y presenting with symptoms of UTI | N = 331 | M = 45.2 (16-99) | 62.8% | ≥ 102 CFU/ml | 225 Physicians from every province in Canada |
Lawson 1973 | Women presenting with symptoms of UTI | N = 343 | M =? (15-55) | 34.4% | ≥ 102 CFU/ml | 2 general practices in the UK |
≥ 103 CFU/ml | ||||||
≥ 105 CFU/ml | ||||||
Nazareth & King 1993 | Women presenting with symptoms of lower UTI | N = 54 | M = 29 (16-45) | 27.8% | ≥ 102 CFU/ml | 2 general practices in the UK |
≥ 103 CFU/ml | ||||||
Little 2006 | Women with suspected UTI | N= 408 | M = ? (17-70) | 62.3% | ≥ 102 CFU/ml | 67 general practices in the UK |
≥ 103 CFU/ml | ||||||
Little 2009 | Women with suspected UTI | N = 431 | M = ? (17-70) | 66.6% | ≥ 102 CFU/ml | 62 general practices in the UK |
≥ 103 CFU/ml | ||||||
Dobbs & Fleming 1987 | Women presenting with symptoms of UTI | N = 238 | M = ? (?) | 35.7% | ≥ 102 CFU/ml | 3 general practices in the UK |
≥ 103 CFU/ml | ||||||
Mond 1965 | Women with symptoms of UTI | N = 83 | M =? (?) | 45.8% | ≥ 102 CFU/ml | 1 general practice in the UK |
≥ 103 CFU/ml | ||||||
≥ 105 CFU/ml | ||||||
Medina-Bombardo 2003 | Women presenting with symptoms of UTI | N = 343 | M = 44 (15-90) | 48.4% | ≥ 102 CFU/ml | 18 primary health care centres in Spain |
≥ 103 CFU/ml | ||||||
≥ 105 CFU/ml | ||||||
Dans & Klaus 1975 | Women complaining of dysuria | N = 84 | M = 26 (19-60) | 46.4% | ≥ 102 CFU/ml | Adult walk-in clinic in the US |
≥ 103 CFU/ml | ||||||
Gallagher 1965 | Women with symptoms of UTI | N = 130 | M=? (?) | 59.2% | ≥ 102 CFU/ml | Urban general practices in New Zealand |
≥ 103 CFU/ml | ||||||
Fahey 2003 | Women presenting with symptoms of UTI | N = 85 | M= (?) | 35.7% | ≥ 102 CFU/ml | 8 general practices in the UK |
≥ 103 CFU/ml | ||||||
≥ 105 CFU/ml | ||||||
Baerheim 2003 | Women with acute dysuria/frequency | N = 252 | M = 46 for UTI + | 63.3% | ≥ 102 CFU/ml | 8 general practices in Norway |
≥ 103 CFU/ml | ||||||
M = 42 for UTI-(18-87) | ≥ 105 CFU/ml | |||||
Osterberg 1996 | Women with symptoms of dysuria/frequency | N= 214 | M = 24 (15-35) | 51.4% | ≥ 102 CFU/ml | 5 primary health care centres in Sweden |
≥ 103 CFU/ml | ||||||
Hummers-Pradier 2005 | Women with symptoms of UTI | N = 227 | M = 53 (?) | 79.3% | ≥ 102 CFU/ml | 36 general practices in Germany |
68.7% | ≥ 103 CFU/ml | |||||
49.3% | ≥ 105 CFU/ml | |||||
O'Brien 2007 | Women with clinically suspected uncomplicated UTI | N = 111 | M = 54 (?) | 32.4% | ≥ 102 CFU/ml | 9 general practices in the UK |
≥ 103 CFU/ml | ||||||
≥ 105 CFU/ml |
Quality assessment
Diagnostic test accuracy of symptoms and signs
Summary estimates across different reference standard thresholds
SYMPTOM | No. of studies | No. of Patient | Sensitivity | (95% CI) | Variance Logit (sensitivity) | Specificity | (95% CI) | Variance Logit (specificity) |
---|---|---|---|---|---|---|---|---|
Dysuria
a
| 14 | 3407 | 0.80 | (0.74-0.86) | 0.40 | 0.38 | (0.31-0.46) | 0.33 |
Frequency
b
| 13 | 2807 | 0.88 | (0.83-0.92) | 0.41 | 0.20 | (0.14-0.28) | 0.58 |
Back pain
c
| 4 | 635 | 0.38 | (0.26-0.52) | 0.22 | 0.57 | (0.40-0.73) | 0.43 |
Fever
d
| 7 | 1250 | 0.10 | (0.04-0.21) | 1.19 | 0.92 | (0.83-0.97) | 1.07 |
Flank pain
e
| 6 | 1340 | 0.26 | (0.19-0.35) | 0.21 | 0.69 | (0.64-0.74) | 0.04 |
Hematuria
| 7 | 1078 | 0.25 | (0.21-0.29) | 0.01 | 0.85 | (0.81-0.89) | 0.05 |
Lower abdominal pain
f
| 7 | 1470 | 0.50 | (0.34-0.66) | 0.75 | 0.50 | (0.34-0.66) | 0.72 |
Nocturia
| 6 | 1720 | 0.59 | (0.50-0.68) | 0.17 | 0.55 | (0.49-0.61) | 0.06 |
Urgency
g
| 9 | 2298 | 0.67 | (0.52-0.80) | 0.95 | 0.45 | (0.31-0.60) | 0.79 |
Vaginal discharge
| 6 | 1261 | 0.15 | (0.08-0.26) | 0.65 | 0.77 | (0.62-0.88) | 0.75 |
SYMPTOM | No. of studies | No. of Patient | Sensitivity | (95% CI) | Variance Logit (sensitivity) | Specificity | (95% CI) | Variance Logit (specificity) |
---|---|---|---|---|---|---|---|---|
Dysuria
a
| 12 | 2845 | 0.79 | (0.72-0.85) | 0.39 | 0.39 | (0.31-0.49) | 0.40 |
Frequency
b
| 11 | 2246 | 0.88 | (0.82-0.92) | 0.43 | 0.21 | (0.14-0.31) | 0.64 |
Back pain
c
| 4 | 635 | 0.38 | (0.26-0.52) | 0.22 | 0.57 | (0.40-0.73) | 0.43 |
Fever
d
| 6 | 926 | 0.12 | (0.05-0.26) | 1.15 | 0.91 | (0.80-0.97) | 1.16 |
Flank pain
e
| 4 | 783 | 0.29 | (0.18-0.43) | 0.31 | 0.65 | (0.59-0.70) | 0.01 |
Hematuria
| 6 | 854 | 0.22 | (0.18-0.27) | 0.02 | 0.87 | (0.81-0.91) | 0.11 |
Lower abdominal pain
f
| 5 | 914 | 0.44 | (0.26-0.64) | 0.78 | 0.58 | (0.37-0.77) | 0.86 |
Nocturia
| 5 | 1492 | 0.59 | (0.48-0.70) | 0.22 | 0.57 | (0.51-0.62) | 0.04 |
Urgency
g
| 7 | 1739 | 0.62 | (0.46-0.76) | 0.72 | 0.51 | (0.35-0.68) | 0.78 |
SYMPTOM | No. of studies | No. of Patient | Sensitivity | (95% CI) | Variance Logit (sensitivity) | Specificity | (95% CI) | Variance Logit (specificity) |
---|---|---|---|---|---|---|---|---|
Dysuria
a
| 7 | 1584 | 0.78 | (0.68-0.86) | 0.42 | 0.36 | (0.26-0.48) | 0.37 |
Frequency
| 6 | 1333 | 0.90 | (0.85-0.94) | 0.22 | 0.17 | (0.11-026) | 0.38 |
Fever
d
| 4 | 742 | 0.10 | (0.04-0.23) | 0.82 | 0.89 | (0.75-0.95) | 0.79 |
Lower abdominal pain
f
| 4 | 784 | 0.40 | (0.21-0.62) | 0.74 | 0.64 | (0.41-0.82) | 0.83 |
Urgency
g
| 4 | 1039 | 0.75 | (0.69-0.80) | 0.05 | 0.36 | (0.27-0.46) | 0.14 |
≥ 102 CFU/ml | ≥ 103 CFU/ml | ≥ 105 CFU/ml | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
SYMPTOM | +LR | (95% CI) | -LR | (95% CI) | +LR | (95% CI) | -LR | (95% CI) | +LR | (95% CI) | -LR | (95% CI) |
Dysuria
| 1.30 | (1.20-1.41) | 0.51 | (0.43-0.61) | 1.31 | (1.18-1.45) | 0.53 | (0.43-0.64) | 1.22 | (1.11-1.34) | 0.61 | (0.50-0.74) |
Frequency
| 1.10 | (1.04-1.16) | 0.60 | (0.49-0.74) | 1.12 | (1.03-1.19) | 0.59 | (0.46-0.76) | 1.09 | (1.02-1.16) | 0.58 | (0.42-0.79) |
Back pain
| 0.90 | (0.71-1.14) | 1.07 | (0.90-1.28) | 0.90 | (0.71-1.14) | 1.07 | (0.90-1.28) | ||||
Fever
| 1.28 | (0.64-2.58) | 0.98 | (0.91-1.05) | 1.39 | (0.63-3.07) | 0.96 | (0.88-1.06) | 0.90 | (0.45-1.80) | 1.01 | (0.93-1.10 |
Flank pain
| 0.85 | (0.67-1.08) | 1.07 | (0.98-1.17) | 0.83 | (0.56-1.24) | 1.09 | (0.92-1.29) | ||||
Hematuria
| 1.72 | (1.30-2.27) | 0.88 | (0.83-0.93) | 1.68 | (1.06-2.66) | 0.89 | (0.82-0.98) | ||||
Lower abdominal pain
| 1.01 | (0.89-1.15) | 0.99 | (0.87-1.13) | 1.06 | (0.88-1.29) | 0.96 | (0.83-1.10) | 1.10 | (0.87-1.38) | 0.94 | (0.82-1.08) |
Nocturia
| 1.30 | (1.08-1.56) | 0.75 | (0.60-0.94) | 1.37 | (1.13-1.65) | 0.72 | (0.56-0.93) | ||||
Urgency
| 1.22 | (1.11-1.34) | 0.73 | (0.62-0.86) | 1.28 | (1.11-1.47) | 0.74 | (0.64-0.85) | 1.17 | (1.04-1.31) | 0.70 | (0.57-0.86) |
Vaginal discharge
| 0.65 | (0.51-0.83) | 1.10 | (1.01-1.20) |
Bayesian analysis and near patient testing (dipstick)
Symptom | Reference standard* | +LR (95%CI) | Post-test probability (95%CI) (%) |
---|---|---|---|
Dysuria
| 102 CFU/ml | 1.30 (1.20-1.41) | 71.0 (70.0-71.0) |
103 CFU/ml | 1.31 (1.18-1.45) | 62.3 (61.0-63.6) | |
105 CFU/ml | 1.22 (1.11-1.34) | 51.1 (49.5-52.8) | |
Frequency
| 102 CFU/ml | 1.10 (1.04-1.16) | 67.8 (67.0-68.5) |
103 CFU/ml | 1.12 (1.03-1.19) | 58.6 (57.5-59.5) | |
105 CFU/ml | 1.09 (1.02-1.16) | 47.8 (46.7-49.0) | |
Hematuria
| 102 CFU/ml | 1.72 (1.30-2.27) | 75.8 (70.9-80.1) |
103 CFU/ml | 1.68 (1.06-2.66) | 67.4 (60.6-73.6) | |
Nocturia
| 102 CFU/ml | 1.30 (1.08-1.56) | 69.4 (67.3-71.3) |
103 CFU/ml | 1.37 (1.13-1.65) | 60.8 (58.4-63.3) | |
Urgency
| 102 CFU/ml | 1.22 (1.11-1.34) | 69.8 (68.5-71.1) |
103 CFU/ml | 1.28 (1.11-1.47) | 61.7 (59.9-63.6) | |
105 CFU/ml | 1.17 (1.04-1.34) | 49.1 (47.1-51.1) | |
Vaginal discharge
| 102 CFU/ml | 0.65(0.51-0.83) | 54.1 (48.3 - 59.9) |
Symptom | Reference standard | Pre-test probability (95%CI) (%) | Post-test probability (95% CI) (LR+) | Post-test probability (95% CI) (LR-) |
---|---|---|---|---|
Dysuria
| 102 CFU/ml | 71.0 (70.0-71.0) | 91.5 (91.2-92.0) | 56.5 (55.3-56.5) |
103 CFU/ml | 62.3 (61.0-63.6) | 88.0 (87.4-88.5) | 46.7 (45.3-48.1) | |
105 CFU/ml | 51.1 (49.5-52.8) | 82.2 (81.2-83.2) | 35.6 (34.2-37.2) | |
Frequency
| 102 CFU/ml | 67.8 (67.0-68.5) | 90.3 (90.0-91.0) | 52.7 (51.8-53.5) |
103 CFU/ml | 58.6 (57.5-59.5) | 86.2 (85.7-87.0) | 42.9 (41.8-43.8) | |
105 CFU/ml | 47.8 (46.7-49.0) | 80.2 (79.5-81.0) | 32.7 (31.7-33.7) | |
Hematuria
| 102 CFU/ml | 75.8 (70.9-80.1) | 93.3 (91.5-95.0) | 62.4 (56.4-68.1) |
103 CFU/ml | 67.4 (60.6-73.6) | 90.1 (87.2-92.5) | 52.3 (44.9-59.6) | |
Nocturia
| 102 CFU/ml | 69.4 (67.3-71.3) | 91.0 (90.1-92.0) | 54.6 (52.1-56.8) |
103 CFU/ml | 60.8 (58.4-63.3) | 87.3 (86.1-88.4) | 45.1 (42.7-47.8) | |
Urgency
| 102 CFU/ml | 69.8 (68.5-71.1) | 91.0 (90.6-91.6) | 55.1 (53.5-56.6) |
103 CFU/ml | 61.7 (59.9-63.6) | 87.7 (86.8-88.5) | 46.1 (44.2-48.1) | |
105 CFU/ml | 49.1 (47.1-51.1) | 81.0 (79.7-82.2) | 33.8 (32.1-35.6) | |
Vaginal discharge
| 102 CFU/ml | 54.1 (48.3 - 59.9) | 84.0 (80.5-86.8) | 38.4 (33.1-44.2) |
Symptom | Reference standard | Pre-test probability (95%CI) (%) | Post-test probability (95%CI) (LR+) | Post-test probability (95% CI) (LR-) |
---|---|---|---|---|
Dysuria
| 102 CFU/ml | 71.0 (70.0-71.0) | 76.9 (76.0-76.9) | 46.8 (45.7-46.8) |
103 CFU/ml | 62.3 (61.0-63.6) | 69.2 (68.0-70.4) | 37.3 (36.0-38.6) | |
105 CFU/ml | 51.1 (49.5-52.8) | 58.7 (57.1-60.3) | 27.3 (26.1-28.7) | |
Frequency
| 102 CFU/ml | 67.8 (67.0-68.5) | 74.1 (73.4-74.7) | 43.1 (42.2-43.9) |
103 CFU/ml | 58.6 (57.5-59.5) | 65.8 (64.8-66.6) | 33.8 (32.8-34.6) | |
105 CFU/ml | 47.8 (46.7-49.0) | 55.5 (54.4-56.6) | 24.8 (24.0-25.7 | |
Hematuria
| 102 CFU/ml | 75.8 (70.9-80.1) | 81.0 (76.8-84.6) | 53.0 (46.7-59.2) |
103 CFU/ml | 67.4 (60.6-73.6) | 73.8 (67.7-79.1) | 42.7 (35.6-50.1) | |
Nocturia
| 102 CFU/ml | 69.4 (67.3-71.3) | 75.5 (73.7-77.2) | 44.9 (42.6-47.2) |
103 CFU/ml | 60.8 (58.4-63.3) | 67.8 (65.6-70.1) | 35.8 (33.6-38.3) | |
Urgency
| 102 CFU/ml | 69.8 (68.5-71.1) | 75.9 (74.7-77.0) | 45.4 (43.9-47.0) |
103 CFU/ml | 61.7 (59.9-63.6) | 68.7 (67.0-70.4) | 36.7 (35.0-38.6) | |
105 CFU/ml | 49.1 (47.1-51.1) | 56.7 (55.0-58.7) | 25.8 (24.3-27.3) | |
Vaginal discharge
| 102 CFU/ml | 54.1 (48.3 - 59.9) | 61.6 (56.0-67.0) | 29.8 (25.2-35.0) |
Symptom | Reference standard | Pre-test probability (95%CI) (%) | Post-test probability (95%CI) (LR+) | Post-test probability (95%CI) (LR-) |
---|---|---|---|---|
Dysuria
| 102 CFU/ml | 71.0 (70.0-71.0) | 86.3(85.7-86.3) | 26.9 (25.9-26.9) |
103 CFU/ml | 62.3 (61.0-63.6) | 80.9(80.1-81.8) | 19.9 (19.0-20.8) | |
105 CFU/ml | 51.1 (49.5-52.8) | 72.9(71.6-74.2) | 13.6 (12.8-14.3) | |
Frequency
| 102 CFU/ml | 67.8 (67.0-68.5) | 84.4(83.9-84.8) | 24.0 (23.3-24.6) |
103 CFU/ml | 58.6 (57.5-59.5) | 78.4(77.7-79.1) | 17.5 (16.9-18.1) | |
105 CFU/ml | 47.8 (46.7-49.0) | 70.2(69.2-71.1) | 12.1 (11.6-12.6) | |
Hematuria
| 102 CFU/ml | 75.8 (70.9-80.1) | 89.0(86.2-91.2) | 32.0 (26.8-37.6) |
103 CFU/ml | 67.4 (60.6-73.6) | 84.2(79.8-87.8) | 23.7 (18.7-29.5) | |
Nocturia
| 102 CFU/ml | 69.4 (67.3-71.3) | 85.4(84.1-86.5) | 25.4 (23.6-27.1) |
103 CFU/ml | 60.8 (58.4-63.3) | 80.0(78.3-81.6) | 18.9 (17.4-20.6) | |
Urgency
| 102 CFU/ml | 69.8 (68.5-71.1) | 85.6(84.8-86.3) | 25.7 (24.6-27.0) |
103 CFU/ml | 61.7 (59.9-63.6) | 80.5(79.3-81.8) | 19.5 (18.3-20.8) | |
105 CFU/ml | 49.1 (47.1-51.1) | 71.3(69.6-72.9) | 12.6 (11.8-13.6) | |
Vaginal discharge
| 102 CFU/ml | 54.1 (48.3 - 59.9) | 75.2 (71.0-79.3) | 15.0(12.3-18.3) |