Diagnostic Performance of Urine Leukocytes in Predicting Urinary Tract Infections among Adult Patients in Kisumu County, Kenya

Abstract

Background: Urinary tract infections (UTI) remain a major global health burden. Diagnosis in resource-limited settings often relies on biochemical markers, like leukocytes. However, the predictive value of leukocyturia in culture-confirmed UTI is under-described in Kisumu, Kenya. Objectives: This study determined the association between urine leukocyturia, uropathogen distribution, and antimicrobial resistance (AMR) among adult patients attending Synergy Clinics. Methods: A retrospective record review was conducted using routine urine, microscopy, culture, and sensitivity testing records. Based on the Cochran formula, a minimum sample size of 255 patient records was calculated, and a total of 348 samples were analysed. Descriptive statistics were used to summarise demographic characteristics. Associations between leukocyturia and culture positivity were assessed using chi-square tests. Logistic regression analysis identified predictors of culture-confirmed bacteriuria. Results: Most participants were male (79.6%). The largest age group was 46–64 years (39.6%). Of the samples, 22.7% were positive for leukocytes. Urine culture positivity was 57.6%, with Escherichia coli (E. coli) as the most frequently isolated pathogen (13.3%). Leukocyturia was significantly associated with culture positivity (p = 0.001). Multivariate analysis identified leukocyturia (odds ratio [OR] 3.36; p = 0.008) and sex (p < 0.001) as significant predictors of culture growth, while age and estimated glomerular filtration rate (eGFR) were not significant. Particularly high AMR was observed against trimethoprim/sulfamethoxazole (SXT) and ampicillin/cloxacillin (AMPCLX). Nitrofurantoin (NIT), aminoglycosides, and carbapenems demonstrated preserved effectiveness. Conclusion: Urine leukocytes were strongly associated with culture-confirmed UTI, supporting their role in diagnostic triage in resource strained settings. The predominance of E. coli and high resistance burden underscores the need for routine culture and susceptibility guided therapy.