Comparison of microbiological diagnosis of urinary tract infection in young children by routine health service laboratories and a research laboratory: Diagnostic cohort study.
Comparison of microbiological diagnosis of urinary tract infection in young children by routine health service laboratories and a research laboratory: Diagnostic cohort study.
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DOI：
10.1371/journal.pone.0171113
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Sterne JA
中科院分区：
文献类型：
--
作者：
Birnie K;Hay AD;Wootton M;Howe R;MacGowan A;Whiting P;Lawton M;Delaney B;Downing H;Dudley J;Hollingworth W;Lisles C;Little P;O'Brien K;Pickles T;Rumsby K;Thomas-Jones E;Van der Voort J;Waldron CA;Harman K;Hood K;Butler CC;Sterne JA
比较常规卫生服务实验室和研究实验室处理的样本之间通过尿培养诊断尿路感染 (UTI) 的有效性。我们对 4808 名就读英国初级卫生保健的 5 岁以下急性病儿童进行了一项前瞻性诊断队列研究。尿路感染的定义是尿路病原体的纯粹/主要生长≥105 CFU/mL（参考标准），在常规卫生服务实验室和中心研究实验室通过尿样培养进行诊断。我们根据样本是通过干净的捕获物还是尿布垫获取，分别计算了通过预先指定的症状、体征和试纸测试结果（“指数测试”）预测的 UTI 的接受者操作曲线下面积 (AUC)。卫生服务和研究实验室分别将 251 名 (5.2%) 和 88 名 (1.8%) 儿童诊断为尿路感染阳性。实验室之间的一致性中等（kappa = 0.36；95% 置信区间 [CI] 0.29, 0.43），干净捕获的一致性（0.54；0.45，0.63）优于尿布垫样品（0.20；0.12，0.28）。在清洁捕获样品中，卫生服务实验室的 AUC（AUC = 0.75；95% CI 0.69，0.80）低于研究实验室（0.86；0.79，0.92）。尿布垫样品的 AUC 值低于清洁捕获样品（卫生服务和研究实验室阳性分别为 0.65 [0.61, 0.70] 和 0.79 [0.70, 0.88]）。比较常规卫生服务实验室与研究实验室的泌尿道感染微生物学诊断一致性，对于清洁捕获样品来说是中等的，而对于尿布垫样品来说是较差的，并且尿布垫的可靠性低于对于清洁捕获样品的可靠性。研究实验室的阳性结果似乎比常规卫生服务实验室的阳性结果更有可能反映真实的尿路感染，其中许多（特别是尿布垫样本）可能是由于污染造成的。卫生服务实验室应考虑采用研究实验室使用的儿科尿液样本程序。初级保健临床医生应尝试获取干净的捕获样本，即使是非常年幼的儿童。
To compare the validity of diagnosis of urinary tract infection (UTI) through urine culture between samples processed in routine health service laboratories and those processed in a research laboratory. We conducted a prospective diagnostic cohort study in 4808 acutely ill children aged <5 years attending UK primary health care. UTI, defined as pure/predominant growth ≥105 CFU/mL of a uropathogen (the reference standard), was diagnosed at routine health service laboratories and a central research laboratory by culture of urine samples. We calculated areas under the receiver-operator curve (AUC) for UTI predicted by pre-specified symptoms, signs and dipstick test results (the “index test”), separately according to whether samples were obtained by clean catch or nappy (diaper) pads. 251 (5.2%) and 88 (1.8%) children were classified as UTI positive by health service and research laboratories respectively. Agreement between laboratories was moderate (kappa = 0.36; 95% confidence interval [CI] 0.29, 0.43), and better for clean catch (0.54; 0.45, 0.63) than nappy pad samples (0.20; 0.12, 0.28). In clean catch samples, the AUC was lower for health service laboratories (AUC = 0.75; 95% CI 0.69, 0.80) than the research laboratory (0.86; 0.79, 0.92). Values of AUC were lower in nappy pad samples (0.65 [0.61, 0.70] and 0.79 [0.70, 0.88] for health service and research laboratory positivity, respectively) than clean catch samples. The agreement of microbiological diagnosis of UTI comparing routine health service laboratories with a research laboratory was moderate for clean catch samples and poor for nappy pad samples and reliability is lower for nappy pad than for clean catch samples. Positive results from the research laboratory appear more likely to reflect real UTIs than those from routine health service laboratories, many of which (particularly from nappy pad samples) could be due to contamination. Health service laboratories should consider adopting procedures used in the research laboratory for paediatric urine samples. Primary care clinicians should try to obtain clean catch samples, even in very young children.