The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients With Lower Urinary Tract Symptoms Without Acute Frequency and Dysuria
The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients With Lower Urinary Tract Symptoms Without Acute Frequency and Dysuria
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DOI：
10.1016/j.juro.2010.01.008
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发表时间：
2010-05-01
影响因子：
6.6
通讯作者：
Malone-Lee, James
中科院分区：
文献类型：
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作者：
Khasriya, Rajvinder;Khan, Shozab;Malone-Lee, James
目的：诊断无排尿困难的慢性下尿路症状患者的尿路感染是关键的一步。在这项研究中，我们仔细检查的敏感性和特异性的试纸尿分析和显微镜下脓尿（10个或更多的白色血细胞每亩），以确定感染在这样的patients.Materials和方法：这是一个前瞻性的，盲目的，观察性队列研究泌尿科门诊患者无痛下尿路症状。分析中段尿和导尿管尿样。共508份中段尿样本用于比较白细胞酯酶、亚硝酸盐试纸和尿显微镜检查，培养物寻求10（5）cfu/ml。同样，使用470份导管尿液样本比较相同的替代物（10（5）cfu/ml）和增强培养法（寻求10（2）cfu/ml）。对508例中段尿和470例导尿管尿标本进行了白细胞酯酶与显微镜下脓尿的比较。结果：对10（5cfu/nal）的中段尿培养，白细胞酯酶的敏感性为56%，亚硝酸盐的敏感性为10%，镜下脓尿的敏感性为56%。特异性分别为66%、99%和72%。对于10（5）cfu/ml的导尿管尿培养标本，白细胞酯酶的敏感性为59%，亚硝酸盐的敏感性为20%，显微镜下脓尿的敏感性为66%。特异性分别为84%、97%和73%。在10（2）cfu/ml的尿液导管标本的增强培养是阳性的29%的患者与15%的10（5）cfu/ml.Conclusions：尽管官方指南和广泛使用这些测试不能被认为是适当的诊断尿路感染的患者下尿路症状，并应放弃在这种情况下。
Purpose: Diagnosing urinary infection in patients with chronic lower urinary tract symptoms without dysuria is a critical step. In this study we scrutinize the sensitivity and specificity of dipstick urinalysis and microscopic pyuria (10 or more white blood cells per mu l) to identify infection in such patients.Materials and Methods: This was a prospective, blinded, observational cohort study of urological outpatients with painless lower urinary tract symptoms. Midstream and catheter urine samples were analyzed. A total of 508 midstream urine samples were used to compare leukocyte esterase, nitrite dipstick and urine microscopy with cultures seeking 10(5) cfu/ml. Similarly 470 catheter urine samples were used to compare the same surrogates with 10(5) cfu/ml and with an enhanced culture method seeking 10(2) cfu/ml. A comparison of leukocyte esterase against microscopic pyuria was made using the 508 midstream and 470 catheter specimens of urine. Midstream urine specimens were provided by 42 normal volunteers for comparison.Results: For a midstream urine culture at 10(5) cfu/nal leukocyte esterase was 56% sensitive, nitrite was 10% sensitive and microscopic pyuria was 56% sensitive. Specificities were 66%, 99% and 72%, respectively. For a catheter specimen of urine culture at 10(5) cfu/ml leukocyte esterase was 59% sensitive, nitrite was 20% sensitive and microscopic pyuria was 66% sensitive. Specificities were 84%, 97% and 73%, respectively. The enhanced culture of catheter specimen of urine at 10(2) cfu/ml was positive in 29% of patients vs 15% at 10(5) cfu/ml.Conclusions: Despite official guidelines and widespread use these tests cannot be considered appropriate for diagnosing urinary tract infection in patients with lower urinary tract symptoms, and should be abandoned in this context.