Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department
Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department
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DOI：
10.5847/wjem.j.1920-8642.2021.02.003
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发表时间：
2021-01-01
影响因子：
2.1
通讯作者：
El Majzoub, Imad
中科院分区：
文献类型：
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作者：
Zgheib, Hady;El Zakhem, Aline;El Majzoub, Imad
背景：尿液研究在检测有泌尿系统症状（使用导尿管或尿液分析呈阳性）的发热性中性粒细胞减少症患者的尿路感染（UTI）方面的作用是无可争议的。然而，对于到急诊室 (ED) 就诊的无症状（即无泌尿系统症状）发热性中性粒细胞减少症 (FN) 患者进行尿液研究的适应症的证据很少。本研究的目的是评估对无症状发热性中性粒细胞减少症患者进行尿液研究的必要性。方法：这是一项对因 FN 就诊且没有泌尿系统症状的成年癌症患者进行的回顾性队列研究。我们纳入了 2013 年 1 月至 2018 年 9 月期间符合条件的患者的所有 ED 表现。Student t 检验和 Wilcoxon 秩和检验用于连续数据，而卡方和 Fisher 精确检验用于分类数据。根据尿培养（UC）结果，参与者被分为两组：UC 阴性和阳性。对于阳性 UC 结果使用两个截止值：>= 10(5) cfu/mL 和 >= 10(4) cfu/mL。 结果：我们的研究中纳入了 284 名患者。我们的患者群体的年龄为 48.5 +/- 18.5 岁。超过三分之二 (68.7%) 的患者患有严重中性粒细胞减少症，而只有 3.9% 和 9.9% 的患者分别在 >= 10(5) cfu/mL 和 >= 10(4) cfu/mL 时出现阳性 UC。大多数尿液分析 (UA) 异常的患者的 UC 预计呈阳性。然而，UCs ≥ 10(5) cfu/mL 和≥ 10(4) cfu/mL 阳性的患者分别有 27.3% 和 32.1% 的 UA 正常。结论：在我们的研究中，在没有泌尿系统症状的情况下到急诊科就诊的成人发热性中性粒细胞减少性癌症患者中 UTI 的发生率较低。因此，在这一人群中可能不需要进行常规尿液检测，因为这会增加患者不必要的经济负担并延误及时治疗。
BACKGROUND: The role of urine studies in the detection of urinary tract infection (UTI) in febrile neutropenic patients with urinary symptoms (having a urinary catheter or having a positive urine analysis) is inarguable. However, the evidence is scarce regarding the indication for urine studies in asymptomatic (i.e., without urinary symptoms) patients with febrile neutropenia (FN) presenting to the emergency department (ED). The aim of this study is to evaluate the need for obtaining urine studies in asymptomatic febrile neutropenic patients.METHODS: This was a retrospective cohort study conducted on adult cancer patients who presented to the ED with FN and had no urinary symptoms. We included all ED presentations of eligible patients between January 2013 and September 2018. Student's t-test and Wilcoxon rank- sum test were used for continuous data, while Chi-square and Fisher's exact tests were used for categorical data. Participants were divided into two groups based on their urine culture (UC) results: negative and positive UCs. Two cut-offs were used for positive UC results: >= 10(5) cfu/mL and >= 10(4) cfu/mL.RESULTS: We included 284 patients in our study. The age of our patient population was 48.5 +/- 18.5 years. More than two-thirds (68.7%) of patients had severe neutropenia, while only 3.9% and 9.9% of the patients had positive UCs at >= 10(5) cfu/mL and >= 10(4) cfu/mL, respectively. UCs were expectedly positive in most patients with urinalysis (UA) abnormalities. However, 27.3% and 32.1% of patients with positive UCs at >= 10(5) cfu/mL and >= 10(4) cfu/mL respectively had a normal UA.CONCLUSIONS: In our study, the incidence of UTI in adult febrile neutropenic cancer patients who present to the ED without urinary symptoms is low. Consequently, routine urine testing may not be warranted in this population, as it adds unnecessary financial burdens on the patients and delays timely management.