BMC Infectious Diseases (Jun 2019)
Clinical usefulness of iQ200/iChem Velocity workstation for screening of urine culture
Abstract
Abstract Background Clinical microbiology laboratories are asked to process large numbers of urine specimens for culture, but only 20–40% of them are positive. Therefore, a rapid, reliable screening method is necessary to speed up the reporting of a negative result. In this study, we evaluated the iQ200/iChem workstation, which is a combination of digital imaging software and a strip reader to predict negative urine culture. Method A total of 1942 urine specimens were processed through both culture and iQ200/ iChem workstation. We analyzed the performance using two definition of positive urine culture; one or two potential uropathogens at a concentration of ≥105 CFU/ml and ≥ 104 CFU/ml. We assessed combinations of parameters (ASP; all small particles, WBC; leukocyte, BACT; bcteria, LE; leukocyte esterase) applying various cut-offs which can achieve the negative predictive value (NPV) ≥97% and culture reduction rate ≥ 50%. Results The culture positive rate was 12.8 and 18.4% applying the criteria of ≥105 CFU/ml and ≥ 104 CFU/ml, respectively. The area under the curve (AUC) of each parameter for ≥105 CFU/ml / ≥104 CFU/ml bacteriuria was 795 /0.719 for WBC, 0.722 / 0.701 for ASP and 0.740 /0.704 for bacteria. Therefore, we investigated the combination of the parameters. With the fixed parameter of BACT≥1/HPF and positive LE, the combinations of WBC ≥ 4/HPF and ASP ≥8500/μl or WBC ≥ 6/HPF and ASP≥5500/μl showed good performance for detecting ≥105 CFU/ml uropathogen. The ranges of sensitivity, specificity, negative predictive value and culture reduction rate were 91.5–92.3%, 49.8–52.6%, 97.7–97.9% and 50.4–53.0%, respectively. However, none of the combined setting yielded acceptable range of NPV for detecting ≥104 CFU/ml uropathogen (NPV 92.9–94.9%). Enterococcus spp. was the most common uropathogen causing the false negative results (55.7%), and also the main pathogen among the positive culture of 104-5 CFU/ml bacteriuria (45%). Conclusions iQ200/iChem workstation was excellent in detection of ≥105 CFU/ml uropathogen, but unsatisfactory in detection of 104–5 CFU/ml uropathogen and Enterococcus spp. It can be useful for screening of urine specimens to reduce bacterial culture. However, notice from clinician will be necessary for specimens from the patients with high risk for UTI, such as pregnant woman, infant, elderly or immune compromised patients.
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