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September 11, 2002

Clinical Diagnosis of Urinary Tract Infection—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(10):1229-1231. doi:10.1001/jama.288.10.1229

In Reply: We agree with Drs Hay and Fahey that the correct use of diagnostic tests requires an accurate assessment of a patient's pretest probability of disease. They were concerned that our reported pretest probability of disease (48%) was too high. They cite 2 other studies,1,2 both with a lower prevalence of UTI in women presenting with symptoms. Unfortunately, we cannot evaluate the first study,1 which is not yet published. Dobbs and Fleming2 did not perform urine cultures on all patients, but instead performed a urine dipstick test on all urine samples, and then performed cultures only when the dipstick result was positive. Since the dipstick test is not as sensitive as a standard culture, this method underestimates the true prevalence of UTI.

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