Evaluation of urinary tract infection among neonates and children using urine FEME and urine culture

Urinary Tract Infection (UTI) is a common cause of serious bacterial illness among infants and children and can result in severe consequences including permanent kidney damage. The diagnosis and management of paediatric UTIs are challenging as it has non-specific symptoms and the confirmatory test is time-consuming. The present study compared the rapid diagnostic technique, full and microscopic examination of urine (Urine FEME), and the confirmatory test, urine culture among suspected neonates and children admitted to Hospital Simunjan, Sarawak, Malaysia. Urine FEME was conducted using a urine dipstick test, for the determination of pH of urine, nitrites, blood, leukocytes, glucose, protein, and ketone levels and as for the microscopic examination, the urine was observed for elements such as pus cells, red blood cells, white blood cells, epithelial cells, bacteria, and yeast cells. Urine samples were cultured on Cysteine Lactose Electrolyte Deficient agar (CLED), blood agar, and MacConkey agar plates to isolate and identify clinically significant microorganisms present in urine causing UTI. Of 145 total cultures, 95 samples were cultured positive for growth. 69.4% of the cultures contain mixed pathogens, 20% were positive for uropathogen Escherichia coli, 4.2% Klebsiella spp., 3.2% Proteus Spp., and 1% Staphylococcus aureus. The positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of the Urine-FEME (leukocyte esterase and nitrite) test were 100%, 79.3%, 86.3% and 100% respectively when compared to urine culture test. Urine microscopy observation generated a positive predictive value (PPV) of 100%, negative predictive value (NPV) of 80.6%, sensitivity and specificity of 87.3% and 100% respectively when compared to urine culture. The present data indicate that both dipstick test and urine microscopy were significantly different (P<0.05) from urine culture in diagnosing UTI. In conclusion, both Urine FEME and urine culture are important methods for the diagnosis of UTI. Urine FEME is a rapid test aids in the early detection of infection and urine culture acts as the gold standard method, which can distinguish between positive or negative culture, thus confirming the uropathogens infection and crucial for UTI management (antibiotic and treatment intervention). Hence, urine culture is integral in UTI diagnosis and cannot be substituted by the Urine FEME test. The present data can be used as a reference and guideline to manage UTI cases and consequently, provides rapid and effective treatment for pediatric UTI.