Accuracy of leukocyte esterase and nitrite tests for diagnosing bacteriuria in older adults: A systematic review and meta-analysis
Abstract
BACKGROUND
Urine dipsticks are commonly used for the diagnosis of bacteriuria and/or urinary tract infections (UTIs).
OBJECTIVES
To perform a systematic review and meta-analysis to evaluate the accuracy of positive leukocyte esterase and/or nitrite results from dipsticks (index test) for diagnosing bacteriuria in older individuals, using urine culture as the reference standard.
DATA SOURCES
MEDLINE (Pubmed), EMBASE, and Cochrane Database of Systematic Reviews from the inception date up to April 2025. We also searched the reference lists of all the studies identified.
STUDY ELIGIBILITY CRITERIA
Both prospective observational cohort and case-control diagnostic studies were included. No language restriction was applied.
PARTICIPANTS
Individuals aged 60 or more with or without symptoms of UTI in the community, nursing homes or hospitalised.
ASSESSMENT OF RISK OF BIAS
We used the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS)-2 tool for assessing risk of bias.
METHODS OF DATA SYNTHESIS
A random-effect meta-analysis was performed to determine the pooled sensitivity, specificity and predictive values of leukocyte esterase and/or nitrites for the detection of bacteriuria. PROSPERO identifier: CRD42024561882.
RESULTS
Of 1,933 articles screened, 16 met inclusion criteria and had moderate risk of bias. Ten studies were hospital-based; six were in nursing homes. Pooled urine dipstick sensitivity and specificity for bacteriuria were 90% (95% CI, 84-94%), and 56%…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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