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Clinical Pediatrics
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False-Negative Urine Latex Particle Agglutination Testing in Neonates With Group B Streptococcal Bacteremia

A Function of Improper Test Implementation?

Jeffrey A. Becker, M.D.

Department of Pediatrics, Walter Reed Army Medical Center, Washington, D.C.

David P. Ascher, M.D.

Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Joe Mendiola, M.D.

Department of Pediatrics, Walter Reed Army Medical Center, Washington, D.C.

Brad Yoder, M.D.

Department of Pediatrics, Wilford Hall Air Force Medical Center, San Antonio, Texas

Martin Weisse, M.D.

Department of Pediatrics, Tripler Army Medical Center, Oahu, Hawaii

Norman Waecker, M.D.

Department of Pediatrics, Naval Hospital San Diego, San Diego, California

William M. Heroman, M.D.

Department of Pediatrics, Naval Hospital San Diego, San Diego, California

Charles Davis, M.D.

Department of Pediatrics, Naval Hospital San Diego, San Diego, California

J.E. Fajardo, M.D.

Department of Pediatrics, Naval Hospital Portsmouth, Portsmouth, Virginia

Gerald W. Fischer, M.D.

Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Although blood cultures remain the most specific indicator of Group B streptococcus (GBS) sepsis, a potentially life-threatening infection in neonates, test results may not be available for 24 to 48 hours. Detection of GBS antigen in the urine by latex particle agglutination (LPA) may speed diagnosis. This study analyzed the sensitivity of the GBS urine LPA assay under clinical conditions. The urine of neonates with early-onset GBS bacteremia was analyzed for GBS antigen over a three-year period at six military medical centers. Overall, 53.5% (38/71) of infants with positive blood cultures had a positive urine LPA test. Only one medical center routinely followed manufacturer's recommendations to concentrate urine specimens before testing. These data suggest that the sensitivity for the urine LPA assay, when performed on unconcentrated urine, is lower than previously reported. Clinicians should insist that the laboratory maximize sensitivity by concentrating urine prior to GBS LPA testing.

Clinical Pediatrics, Vol. 32, No. 8, 467-471 (1993)
DOI: 10.1177/000992289303200805
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S. R. Allen
Management of Asymptomatic Term Neonates Whose Mothers Received Intrapartum Antibiotics--Part 2: Diagnostic Tests and Management Strategies
Clinical Pediatrics, November 1, 1997; 36(11): 617 - 624.
[Abstract] [PDF]