ArticleJournal of clinical microbiology2015
Lack of clinical utility of urine gram stain for suspected urinary tract infection in pediatric patients.
Article in Journal of clinical microbiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Diagnostic value of biomarkers for paediatric urinary tract infections in primary care: systematic review and meta-analysis.BMC family practice · 2021Pooled it
- Gram staining decipherment using an artificial intelligence-powered smartphone-based application.Microbiology spectrum · 2026Observational
- Determining causal pathogens and inflammatory state of mastitis in dairy cows via Gram staining of precipitates in milk.Frontiers in veterinary science · 2024Article
- Teleclinical Microbiology: An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria.American journal of clinical pathology · 2022Article
- Point-of-care urine Gram stain led to narrower-spectrum antimicrobial selection for febrile urinary tract infection in adolescents and adults.BMC infectious diseases · 2022Observational
- The Role of Gram-Negative Bacteria in Urinary Tract Infections: Current Concepts and Therapeutic Options.Advances in experimental medicine and biology · 2021Review
- Utility of point-of-care Gram stain by physicians for urinary tract infection in children ≤36 months.Medicine · 2019Observational
- Diagnosis of Urinary Tract Infections in Children.Journal of clinical microbiology · 2016Review
- Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Urinary tract infection (UTI) is one of the most common infections in children. Urine culture remains the gold standard for diagnosis, but the utility of urine Gram stain relative to urinalysis (UA) is unclear. We reviewed 312 pediatric patients with suspected UTI who had urine culture, UA, and urine Gram stain performed from a single urine specimen. UA was considered positive if ≥10 leukocytes per oil immersion field were seen or if either nitrates or leukocyte esterase testing was positive. Urine Gram stain was considered positive if any organisms were seen. Sensitivity, specificity, and positive and negative predictive values were calculated using urine culture as the gold standard. Thirty-seven (12%) patients had a culture-proven UTI. Compared to urine Gram stain, UA had equal sensitivity (97.3% versus 97.5%) and higher specificity (85% versus 74%). Empirical therapy was prescribed before the Gram stain result was known in 40 (49%) patients and after in 42 (51%) patients. The antibiotics chosen did not differ between the two groups (P=0.81), nor did they differ for patients with Gram-negative rods on urine Gram stain compared to those with Gram-positive cocci (P=0.67). From these data, we conclude that UA has excellent negative predictive value that is not enhanced by urine Gram stain and that antibiotic selection did not vary based on the urine Gram stain result. In conclusion, the clinical utility of urine Gram stain does not warrant the time or cost it requires.
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