Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with rheumatoid arthritis (RA) treated with biologic
agents are at increased risk of infection. Therefore, screening for urinary
tract infection (UTI) with urine dipsticks (UD) is often performed as part of
monitoring in the daily clinic regardless of UTI symptoms. We examined the prevalence of bacteriuria
detected by UD and urine culture (UC), and the value of UD compared to UC in TNFi-treated RA patients. Secondary aims were to assess the
reproducibility of UD and the association between UTI symptoms and results of UD
and UC.
Methods: Urine
samples from 126 adult RA patients treated with TNFi for ³ 6 months were
collected according to standard guidelines and tested twice by use of an automated
UD test (Clinitek) (one patient
had only one UD performed), followed by quantitative UC. Positive UD
test was defined as presence of
leucocyte esterase and/or nitrite. UC with more than 100,000 CFU/mL was considered
positive. True and false positive and negative rates (TPR, FPR, TNR and FNR) and
positive and negative predictive values (PPV and NPV) were calculated. Cross-tabulations
and X2-tests were used to analyze the results.
Results:
Patient characteristics are
shown in Table 1 and urine test results in Table 2 and 3. Only one patient (0.8%)
had UTI symptoms (UD negative). 4.8% (n = 6) of the patients had a positive UC.
None of these had UTI symptoms and only 50% (n = 3) were UD positive (dipstick
1, 2 or both). In the patients as a whole (n = 126), UD was positive in 23% of
the cases but only 10.3% (PPV) of these had a positive UC. The NPV for UD was
96.9% versus 95.2% for UTI symptoms. Duplicate UD results agreed (positive or
negative) in 97.6% of the cases indicating high reproducibility.
Conclusion: Less than 5% of RA patients treated with
TNFi had a positive UC, none of these had UTI
symptoms and UD detected only half of the cases. The PPV for UD was only 10%.
The NPV for UD was high, reflecting
the low prevalence of positive UC in the study population. The results question
the value of general UTI screening with UD and/or UC in the daily clinic.
Table 1. Basic characteristics of 126 RA patients.
|
Male:female ratio
|
1:3
|
|
Age at diagnosis (yrs), mean/SD (range)
|
44/14.13 (11.1-76.8)
|
|
Time since diagnosis (yrs), mean/SD (range)
|
15.1/10.7 (1.4-43.9)
|
|
Length of treatment with TNFi (yrs), mean/SD (range)
|
4.5/3.4 (0.1-12.9)
|
|
Positive RF and/or anti-CCP, n /%
|
84/67 (unknown in 7)
|
|
Erosive disease, n /%
|
69/55
|
|
Concomitant DMARDs, n /%
|
102/81
|
|
DAS28-CRP, mean/SD (range)
|
2.64/0.97 (1.2-6.5)
|
|
HAQ-DI, mean/SD (range)
|
0.78/0.65 (0-2.88)
|
Table 2. Urine dipstick (UD) compared
with urine culture (UC).
|
|
UD pos |
UD neg |
Totals
|
|
UC pos |
3 |
3 |
6 |
|
UC neg |
26 |
94 |
120 |
|
Totals
|
29 |
97 |
126 |
|
PPV=10.3; NPV=96.9; TPR=50; TNR=78.3; FPR =21.6; FNR=50.0 [all in %]; X2=2.6, p= 0.11
|
|||
Table 3. Urinary tract infection
(UTI) symptoms compared
with urine culture (UC).
|
+UTI symp. |
– UTI symp. |
Totals |
|
|
UC pos |
0
|
6
|
6
|
|
UC neg |
1
|
119
|
120
|
|
Totals |
1
|
125
|
126
|
|
PPV= 0; NPV=95.2; TPR=0; TNR=99.2; FPR=0.8; FNR=100 [all in %]; X2 =0.05, p=0.82
|
|||
To cite this abstract in AMA style:
Baronaite Hansen R, Brun Hesselvig A, Arpi RM, Jonassen EK, Bukh G, Rintek Madsen O. Screening for Urinary Tract Infection in Rheumatoid Arthritis Patients Treated with TNF-Inhibitors in the Daily Clinic [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/screening-for-urinary-tract-infection-in-rheumatoid-arthritis-patients-treated-with-tnf-inhibitors-in-the-daily-clinic/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/screening-for-urinary-tract-infection-in-rheumatoid-arthritis-patients-treated-with-tnf-inhibitors-in-the-daily-clinic/