Cut-off Values of Bacteriuria and Leukocyturia for the Diagnosis of Urinary Tract Infections in Pediatric Patients

Muhamad Ramdani Ibnu Taufik, Dian Ariningrum, Yusuf Ari Mashuri


The diagnosis of Urinary Tract Infection (UTI) in infants and children is often missed. There have been no studies on
diagnostic tests using automated urine analyzer in pediatric patients. This study aimed to determine the cut-off values of
bacteriuria and leukocyturia using the automated urine analyzer Sysmex UX-2000 to diagnose UTI with the gold standard of
automated urine culture using VITEK 2 in pediatric patients at Dr. Moewardi Hospital, Surakarta. An observational analytical
study with the cross-sectional design was during August-October 2019 at the Clinical Pathology Laboratory and Clinical
Microbiology Laboratory of Moewardi Hospital, Surakarta. Eighty-four patients sample were collected. This study's
dependent variable was the diagnosis of urinary tract infections in pediatric patients established with positive culture results
(bacterial count of ≥ 105 CFU/mL urine). This study's independent variables were the number of urine bacteria (BACT) and
the number of urine leukocytes (WBC) from urinalysis using the Sysmex UX-2000 automated urine analyzer. A diagnostic
test was used for data analysis. The best cut-off value for leukocyturia was 37 cells/μL with a 61.1% sensitivity, 63.6%
specificity, a positive predictive value of 31.4%; a negative predictive value of 85.7; positive likelihood ratio of 1.64; negative
likelihood ratio of 0.595, and accuracy of 63%. The best cut-off for the number of bacteria was 143 cells/μL with a sensitivity
of 66.7%; specificity of 71.2%, the positive predictive value of 38.7%, the negative predictive value of 88.7%; positive
likelihood ratio of 2.14; negative likelihood ratio of 0.432 and an accuracy of 70.2%. A cut-off of 37 cells/μL for leukocyturia
and 143 cells/μL for bacteriuria using an automated urine analyzer can be used for UTI screening in pediatric patients.


Urinary tract infections, children, leukocyturia, bacteriuria, Sysmex UX-2000

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Seputra KP, Tarmono Bambang SN, Chaidir AM, Irfan

W, Johan R, DKK. Guideline penatalaksanaan infeksi

saluran kemih dan genitalia pria 2015. Jakarta, Ikatan

Ahli Urologi Indonesia, 2015; 44-57.

Musim. Enhanced urinalysis dengan urin mid-stream

sebagai uji diagnostik infeksi saluran kemih pada anak

[Tesis]. Yogyakarta, Program Pasca Sarjana Universitas

Gadjah Mada, 2007; 1-80.

Sutanto K. Validitas dan cut-off bakteri urine

berdasarkan metode flow cytometry untuk

mendiagnosis infeksi bakteri saluran kemih [Tesis].

Surakarta, Program Pendidikan Dokter Spesialis

Patologi Klinik Universitas Sebelas Maret, 2012; 1-70.

Sysmex Corporation. Fully automated integrated urine

analyzer UX-2000 Instructions for Use. Japan, Kobe,

; 315-344.

Pratistha FSM, Sudhana IW, Adnyana IWL. Diagnosis

cepat infeksi saluran kemih dengan menghitung

jumlah leukosituria pada urinalisis metode flow

cytometry Sysmex UX-2000 dengan baku emas kultur

urin di RSUP Sanglah Denpasar. E-Jurnal Medika

Udayana, 2018; 7(5): 211-216.

Bargotya M, Kumar L, Das P, Kachhap P, Sachdeva V,

Monika K. Evaluation of advantages of multiple

parameters of an automated urine analyzer in clinical

practice. Ann Clin Cytol Pathol, 2018; 4(5): 1110.

Giesen C, Greeno A, Thompson K. Performance of flow

cytometry to screen urine for bacteria and white blood

cell prior to urine culture. Clin Biochem, 2013; 4(2): 68-72.

Agpaoa VV, Mendoza JB, Fernandez AJM, Veloso JD,

Bhatnagar S. Predict urinary tract infection and to

estimate causative bacterial class in a Philippine

subspecialty hospital. Journal of Nephrology &

Therapeutics, 2015; 194: 1-2.



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