PYURIA AND BACTERIURIA IN URINE SPECIMENS OBTAINED BY CATHETER FROM YOUNG-CHILDREN WITH FEVER
PYURIA AND BACTERIURIA IN URINE SPECIMENS OBTAINED BY CATHETER FROM YOUNG-CHILDREN WITH FEVER
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DOI：
10.1016/s0022-3476(05)83127-0
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发表时间：
1994-04-01
影响因子：
5.1
通讯作者：
CHARRON, M
中科院分区：
文献类型：
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作者：
HOBERMAN, A;WALD, ER;CHARRON, M
对2181例24个月以下发热儿童尿液标本的尿液分析和培养结果进行了分析，以确定：(1)临床上细菌菌落计数的最佳界值；(2)白细胞酯酶和亚硝酸盐试验在鉴别脓尿和菌尿方面的准确性；(3)脓尿(定义为大于或等于10个白细胞/mm(3))在鉴别尿路感染和无症状菌尿中的作用。在每毫升尿培养菌落数大于或等于10,000个/毫升的标本中，92个(84%)大于或等于100,000个菌落单位/毫升，10个(9%)的菌落数在50,000~99,000个/毫升之间，8个(7%)在10,000~49,000个菌落单位/毫升。白细胞计数<10个/mm(3)几乎总是与无菌培养有关，102例>50,000 cfu/ml的患者中93例>10个/mm(3)，纸片法检测>10个/mm(3)和>20个/mm(3)的敏感性分别为52.9%和66.7%。亚硝酸盐纸片试验检测菌尿(大于或等于5000CFU/ml)的敏感性为31.4%。65例肾小球数大于或等于10个/mm(3)的患者中，50例(77%)经99m标记的二硫代丁二酸肾扫描诊断为急性肾盂肾炎，而5例10个白细胞/mm(3)的患者中无一例诊断为急性肾盂肾炎(p<；0.01)。这五名患者的发现与尿路定植一致，而不是感染。对于通过导尿管获得的尿样，我们认为尿路感染最好的定义是白细胞数大于或等于10/mm(3)和CFU数大于或等于50,000/ml。这一定义几乎总是区分真正的尿路感染、尿液标本污染引起的菌尿和无症状菌尿。
Results of urinalysis and culture of 2181 urine specimens obtained by catheter from febrile children aged less than 24 months were analyzed to determine the following: (I) an optimal cutoff point in considering a bacterial colony count clinically ''significant,'' (2) the accuracy of leukocyte esterase and nitrite tests in identification of pyuria and bacteriuria, and (3) the utility of pyuria (defined as greater than or equal to 10 leukocytes/mm(3)) in the discrimination of urinary tract infection from asymptomatic bacteriuria. Among 110 urine cultures with greater than or equal to 10,000 colony-forming units per milliliter, 92 (84%) had greater than or equal to 100,000 CFU/ml, 10 (9%) had 50,000 to 99,000 CFU/ mt, and 8 (7%) had 10,000 to 49,000 CFU/ml. Urine specimens with 1000 to 49,000 CFU/ml were more likely than specimens with greater than or equal to 50,000 CFU/ml to yield Grampositive or mixed organisms (36/60 vs 7/109; p < 0.001). A count of < 10 leukocytes/mm(3) was almost invariably associated with a sterile culture; a count of greater than or equal to 10 leukocytes/mm(3) was found in 93 of 102 patients with greater than or equal to 50,000 CFU/ml. The dipstick leukocyte esterase test had sensitivities of 52.9% and 66.7% in detecting greater than or equal to 10 leukocytes/mm(3) and greater than or equal to 20 leukocytes/mm(3), respectively. The dipstick nitrite test had a sensitivity of 31.4% in detecting bacteriuria (greater than or equal to 50,000 CFU/ml). Acute pyelonephritis was diagnosed by a renal scan with dimercaptosuccinic acid labeled with technetium 99m in 50 (77%) of 65 patients with greater than or equal to 10 leukocytes/mm(3) but in none of five patients with < 10 leukocytes/mm(3) (p < 0.01). The findings in these five patients were consistent with colonization of the urinary tract rather than infection. For urine specimens obtained by catheter, we believe that urinary tract infection is best defined by both a leukocyte count greater than or equal to 10/mm(3) and a CFU count greater than or equal to 50,000/ml. This definition almost always discriminates among true urinary tract infection, bacteriuria resulting from contamination of the urine specimen, and asymptomatic bacteriuria.