Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection
Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection
复制标题
DOI：
10.1128/jcm.01452-18
复制
发表时间：
2019-03-01
影响因子：
9.4
通讯作者：
Rohn, Jennifer L.
中科院分区：
文献类型：
--
作者：
Sathiananthamoorthy, Sanchutha;Malone-Lee, James;Rohn, Jennifer L.
中段尿（MSU）培养仍然是诊断尿路感染（UTI）的金标准。我们以前的研究表明，慢性下尿路症状（LUTS）低于MSU培养诊断临界值的患者可能仍然存在细菌感染，并且他们的抗生素治疗与症状缓解相关。在这里，我们评估的结果，英国的MSU文化的症状患者和对照组。接下来，我们比较了MSU培养物与50-ILI未离心培养物、30-m1离心沉淀培养物和16 S rRNA基因测序的细菌富集能力。本研究对33例首次就诊的LUTS患者（平均年龄48.7岁;标准差[SD] 16.5岁）、30例症状复发的治疗中的LUTS患者（平均年龄47.8岁; SD 16.5岁）和29例无症状对照（平均年龄40.7岁，SD 15.7岁）的尿液标本进行了研究。我们发现，常规MSU培养，采用英国的解释标准为急性UTI量身定制，未能检测到各种细菌物种，包括公认的尿路病原体。此外，诊断性MSU培养无法区分患者和对照组。相比之下，通过离心富集的尿液的基因组分析区分了各组，对物种丰富度产生了更准确的理解。总之，英国的MSU方案遗漏了相当大比例的细菌，包括公认的泌尿系病原体，可能不适合排除LUTS患者的UTI。
Midstream urine (MSU) culture remains the gold standard diagnostic test for confirming urinary tract infection (UTI). We previously showed that patients with chronic lower urinary tract symptoms (LUTS) below the diagnostic cutoff on MSU culture may still harbor bacterial infection and that their antibiotic treatment was associated with symptom resolution. Here, we evaluated the results of the United Kingdom's MSU culture in symptomatic patients and controls. Next, we compared the bacterial enrichment capabilities of the MSU culture with those of a 50-ILI uncentrifuged culture, a 30-m1 centrifuged sediment culture, and 16S rRNA gene sequencing. This study was conducted on urine specimens from 33 LUTS patients attending their first clinical appointment (mean age, 48.7 years; standard deviation [SD], 16.5 years), 30 LUTS patients on treatment (mean age, 47.8 years; SD, 16.5 years) whose symptoms had relapsed, and 29 asymptomatic controls (mean age, 40.7 years, SD, 15.7 years). We showed that the routine MSU culture, adopting the UK interpretation criteria tailored to acute UTI, failed to detect a variety of bacterial species, including recognized uropathogens. Moreover, the diagnostic MSU culture was unable to discriminate between patients and controls. In contrast, genomic analysis of urine enriched by centrifugation discriminated between the groups, generating a more accurate understanding of species richness. In conclusion, the United Kingdom's MSU protocol misses a significant proportion of bacteria, which include recognized uropathogens, and may be unsuitable for excluding UTI in patients with LUTS.