Voided midstream urine culture and acute cystitis in premenopausal women.
Voided midstream urine culture and acute cystitis in premenopausal women.
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DOI：
10.1056/nejmoa1302186
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发表时间：
2013-11-14
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影响因子：
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通讯作者：
Stapleton AE
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作者：
Hooton TM;Roberts PL;Cox ME;Stapleton AE
急性单纯性膀胱炎的病因是根据中流尿培养物确定的，但很少有数据指导对此类结果的解释，特别是当革兰氏阳性菌生长时。 18至49岁有膀胱炎症状的女性提供中流尿标本，然后通过导尿管收集尿液进行培养（导尿管尿）。我们比较了配对样本中的微生物种类和菌落计数。主要结果是比较中段尿液中生长的微生物的阳性预测值和阴性预测值，并以导管尿液中是否存在微生物作为参考。对 226 名女性的 236 次膀胱炎发作进行分析，得到了 202 份配对的中流尿和导管尿样本，可以进行评估。 142 份导管标本 (70%) 的尿路病原体培养物呈阳性，其中 4 份含有一种以上尿路病原体，157 份中游标本 (78%) 的尿路病原体培养结果呈阳性。即使在计数非常低的情况下，中流尿液中大肠杆菌的存在也能高度预测膀胱菌尿，阳性预测值为每毫升 102 个菌落形成单位 (CFU)，占 93%（Spearman’s r = 0.944）。相比之下，在中流尿中，肠球菌（培养物中占 10%）和 B 族链球菌（培养物中占 12%）在任何菌落计数下都不能预测膀胱菌尿（肠球菌的 Spearman r = 0.322，B 族链球菌的 Spearman r = 0.272）。在中流尿液中发现肠球菌、B 族链球菌或两者的 41 次事件中，61% 的导管尿液培养物中生长出大肠杆菌。对患有急性单纯性膀胱炎的健康绝经前妇女的中流尿进行培养，准确地显示出膀胱大肠杆菌的证据，但没有肠球菌或 B 族链球菌的证据，这些细菌通常与大肠杆菌分离，但似乎很少单独引起膀胱炎。 （由国家糖尿病、消化和肾脏疾病研究所资助。）
The cause of acute uncomplicated cystitis is determined on the basis of cultures of voided midstream urine, but few data guide the interpretation of such results, especially when gram-positive bacteria grow. Women from 18 to 49 years of age with symptoms of cystitis provided specimens of midstream urine, after which we collected urine by means of a urethral catheter for culture (catheter urine). We compared microbial species and colony counts in the paired specimens. The primary outcome was a comparison of positive predictive values and negative predictive values of organisms grown in midstream urine, with the presence or absence of the organism in catheter urine used as the reference. The analysis of 236 episodes of cystitis in 226 women yielded 202 paired specimens of midstream urine and catheter urine that could be evaluated. Cultures were positive for uropathogens in 142 catheter specimens (70%), 4 of which had more than one uropathogen, and in 157 midstream specimens (78%). The presence of Escherichia coli in midstream urine was highly predictive of bladder bacteriuria even at very low counts, with a positive predictive value of 102 colony-forming units (CFU) per milliliter of 93% (Spearman’s r = 0.944). In contrast, in midstream urine, enterococci (in 10% of cultures) and group B streptococci (in 12% of cultures) were not predictive of bladder bacteriuria at any colony count (Spearman’s r = 0.322 for enterococci and 0.272 for group B streptococci). Among 41 episodes in which enterococcus, group B streptococci, or both were found in midstream urine, E. coli grew from catheter urine cultures in 61%. Cultures of voided midstream urine in healthy premenopausal women with acute uncomplicated cystitis accurately showed evidence of bladder E. coli but not of enterococci or group B streptococci, which are often isolated with E. coli but appear to rarely cause cystitis by themselves. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)