TY - JOUR
T1 - Diapers as Promising Alternative Collection Method for Urine Specimens in Nursing Home Residents
T2 - A Noninferiority Study
AU - Kuil, Sacha D.
AU - Hidad, Soemeja
AU - Fischer, Johan C.
AU - Visser, Caroline E.
AU - van Leth, Frank
AU - de Jong, Menno D.
AU - Schneeberger, Caroline
N1 - Funding Information: This work was supported by The Netherlands Organization for Health Research and Development, ZonMw (Grant 541001003).We thank Dr. J. Harting (Amsterdam UMC, Department of Public Health, Amsterdam) for comments on the manuscript. This study is funded by The Netherlands Organization for Health Research and Development (ZonMw) grant 541001003. ZonMw, Laan van Nieuw Oost Indi? 334, 2593 CE Den Haag, The Netherlands. The funder had no role in study design, data collection and interpretation, or to submit the work for publication. The dataset is fully accessible under CC0 license on figshare via DOI: 10.21942/uva.12608645. Publisher Copyright: © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2021/6
Y1 - 2021/6
N2 - Objective: There is unmet need for an easy, noninvasive urine collection method to diagnose urinary tract infections (UTIs) in nursing home residents suffering from urinary incontinence or cognitive impairments. UTIs are highly prevalent in nursing home residents, and urine specimen collection can be difficult. The objective of this study was to assess if urine specimens collected from super-absorbing incontinence pads (adult diapers) are a reliable collection method for UTI diagnosis. Design: This was a paired noninferiority laboratory study, in which pairing refers to UTI diagnostics performed directly using clinical urine specimens (reference specimen) and indirectly using urine extracted from diapers (diaper specimen). Setting and participants: In this study, remnants of 250 clinical urine specimens were used to assess noninferiority in diagnosing UTIs, based on a 1-sided type I error of 2.5%, a power of 90%, and a noninferiority margin of 15%. Methods: Urine specimens were poured on super-absorbing disposable adult diapers and extracted after 3 hours, to use for dipstick urinalysis and bacterial culture. UTIs were defined as presence of leukocytes and a positive bacterial culture. Noninferiority was assessed by calculating a Wald-type test statistic. Results: Noninferiority was established for diagnosing UTIs in diaper specimens, and for each of its components (dipstick leukocyte detection and bacterial culture positivity). Positive bacterial cultures were found in 72 (29.0%) diaper specimens compared with 65 (26.2%) reference specimens (difference −2.8%, 97.5% CI −7.1% to 1.5%). Leukocytes were present in 162 (64.8%) diaper specimens, compared with 175 (70.0%) reference specimens (difference −5.7%, 97.5% CI: −10.6% to −0.7%). Conclusion and implications: Our results on diagnosing UTIs, by dipstick analysis and bacterial cultures, using super-absorbing adult diapers are promising. Before translation into clinical practice, further studies are needed to evaluate the risk of bacterial contamination by wearing adult diapers, possibly resulting in overdiagnosis of UTI.
AB - Objective: There is unmet need for an easy, noninvasive urine collection method to diagnose urinary tract infections (UTIs) in nursing home residents suffering from urinary incontinence or cognitive impairments. UTIs are highly prevalent in nursing home residents, and urine specimen collection can be difficult. The objective of this study was to assess if urine specimens collected from super-absorbing incontinence pads (adult diapers) are a reliable collection method for UTI diagnosis. Design: This was a paired noninferiority laboratory study, in which pairing refers to UTI diagnostics performed directly using clinical urine specimens (reference specimen) and indirectly using urine extracted from diapers (diaper specimen). Setting and participants: In this study, remnants of 250 clinical urine specimens were used to assess noninferiority in diagnosing UTIs, based on a 1-sided type I error of 2.5%, a power of 90%, and a noninferiority margin of 15%. Methods: Urine specimens were poured on super-absorbing disposable adult diapers and extracted after 3 hours, to use for dipstick urinalysis and bacterial culture. UTIs were defined as presence of leukocytes and a positive bacterial culture. Noninferiority was assessed by calculating a Wald-type test statistic. Results: Noninferiority was established for diagnosing UTIs in diaper specimens, and for each of its components (dipstick leukocyte detection and bacterial culture positivity). Positive bacterial cultures were found in 72 (29.0%) diaper specimens compared with 65 (26.2%) reference specimens (difference −2.8%, 97.5% CI −7.1% to 1.5%). Leukocytes were present in 162 (64.8%) diaper specimens, compared with 175 (70.0%) reference specimens (difference −5.7%, 97.5% CI: −10.6% to −0.7%). Conclusion and implications: Our results on diagnosing UTIs, by dipstick analysis and bacterial cultures, using super-absorbing adult diapers are promising. Before translation into clinical practice, further studies are needed to evaluate the risk of bacterial contamination by wearing adult diapers, possibly resulting in overdiagnosis of UTI.
KW - Adult
KW - Humans
KW - Nursing Homes
KW - Urinalysis
KW - Urinary Incontinence
KW - Urinary Tract Infections/diagnosis
KW - Urinary tract infections
KW - incontinence pads
KW - older adults
KW - urine incontinence
KW - urine specimen collection method
UR - http://www.scopus.com/inward/record.url?scp=85097476179&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jamda.2020.10.003
DO - https://doi.org/10.1016/j.jamda.2020.10.003
M3 - Article
C2 - 33303395
SN - 1525-8610
VL - 22
SP - 1222-1227.e1
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 6
ER -