Assessment of Urinalysis and Urine Culture Agreement in Diagnosing Urinary Tract Infections at a Hospital in Ebonyi State, South East Nigeria

Dipstick urinalysis is widely used as a rapid screening tool for urinary tract infection, but its concordance with definitive urine culture results requires evaluation in local clinical contexts to inform appropriate diagnostic pathways. This study assessed the agreement between dipstick urinalysis and midstream urine culture in diagnosing urinary tract infections at Federal Teaching Hospital Abakaliki, Ebonyi State, South East Nigeria. A cross-sectional comparative study was conducted on 260 midstream urine samples collected from symptomatic patients referred for UTI investigation. Dipstick testing for leucocyte esterase and nitrites was performed immediately upon sample receipt, followed by culture on cysteine lactose electrolyte-deficient agar and blood agar. Significant growth was defined as 100,000 CFU/mL or above. Sensitivity, specificity, and kappa agreement were calculated. Culture confirmed significant bacteriuria in 34.6% of samples. Leucocyte esterase alone showed sensitivity of 80.0% and specificity of 72.4%. Nitrite alone had sensitivity of 52.2% and specificity of 91.3%. Combined leucocyte esterase and nitrite positivity had sensitivity of 76.7% and specificity of 88.4%. Kappa coefficient indicated moderate agreement at 0.58. False negatives occurred disproportionately in samples from diabetic patients and those with recent antibiotic use. The study concludes that dipstick urinalysis is useful for rapid screening but should not replace culture for definitive diagnosis, especially in high-risk populations, and recommends clear UTI diagnostic algorithms for South East Nigerian hospitals. Keywords: urinalysis, urine culture, urinary tract infection, leucocyte esterase, Ebonyi State