Overtreatment of Presumed Urinary Tract Infection in Older Women Presenting to the Emergency Department
Overtreatment of Presumed Urinary Tract Infection in Older Women Presenting to the Emergency Department
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DOI：
10.1111/jgs.12203
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发表时间：
2013-05-01
影响因子：
6.3
通讯作者：
Mermel, Leonard A.
中科院分区：
文献类型：
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作者：
Gordon, Lesley B.;Waxman, Michael J.;Mermel, Leonard A.
目的了解急诊科（艾德）就诊的老年女性在尿培养阴性的情况下被诊断为尿路感染（UTI）的频率，并调查通过导管插入而不是干净收集尿液是否能提高尿液分析（UA）的准确性。设计回顾性病历审查。设置学术附属艾德在罗得岛的普罗维登斯。研究对象为2008年12月1日至2010年3月1日期间在艾德门诊诊断为UTI的153名70岁及以上女性。测量主诉、系统审查、UA和培养结果、尿液采集（干净收集、直导管或新插入的Foley导管）、给予或处方抗生素和诊断。确认的UTI定义为尿液培养阳性，清洁收集标本的微生物生长≥ 10，000菌落形成单位（CFU）/ mL，新插入导管标本的微生物生长≥ 100 CFU/mL; UTI的艾德诊断定义为艾德医生的指定。结果在153例ED诊断为UTI的患者中，只有87例（57%）根据培养证实了UTI。在其余66例阴性培养中，63例（95%）在ED中给予或处方抗生素。尿液采集方法影响UA预测培养结果的能力（P= 0.02），导管插入术产生的假阳性UA比例（31%）低于清洁捕获（48%）。结论：在艾德环境中诊断为UTI的老年妇女中，近一半的人在尿培养中没有得到证实，因此没有得到适当的治疗。在评估老年女性是否存在UTI时，导管插入术可提高UA的准确性。
Objectives To determine how often older women presenting to an emergency department (ED) are diagnosed with a urinary tract infection (UTI) without a positive urine culture and to investigate whether collecting urine by catheterization instead of clean catch improves the accuracy of the urinalysis (UA). Design Retrospective chart review. Setting Academic-affiliated ED in Providence, Rhode Island. Participants One hundred fifty-three women aged 70 and older with diagnosis of UTI in the ED between December 1, 2008, and March 1, 2010. Measurements Chief complaint, review of systems, results of UA and culture, urine procurement (clean catch, straight catheter, or newly inserted Foley catheter), antibiotic administered or prescribed, and diagnosis. A confirmed UTI was defined as a positive urine culture, with microbial growth of 10,000 colony-forming units (CFU)/ mL or more for clean-catch specimens and 100CFU/mL or more for newly inserted catheter specimens; an ED diagnosis of UTI was defined as the designation by an ED physician. Results Of 153 individuals with an ED-diagnosed UTI, only 87 (57%) had confirmed UTI according to culture. Of the remaining 66 with negative cultures, 63 (95%) were administered or prescribed antibiotics in the ED. The method of urine procurement affected the ability of a UA to predict the culture result (P=.02), with catheterization yielding a lower proportion of false-positive UA (31%) than clean catch (48%). Conclusion Nearly half of older women diagnosed with a UTI in an ED setting did not have confirmatory findings on urine culture and were therefore inappropriately treated. Catheterization improved the accuracy of UA when assessing older women for possible UTI.