Evaluation of a Novel Light Scattering Methodology for the Detection of Pathogenic Bacteria in Urine
Evaluation of a Novel Light Scattering Methodology for the Detection of Pathogenic Bacteria in Urine
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DOI：
10.1093/jalm/jfz013
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发表时间：
2020-03-01
影响因子：
2
通讯作者：
Isbella, T. Scott
中科院分区：
文献类型：
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作者：
Davaro, Elizabeth;Tomaras, Andrew P.;Isbella, T. Scott
背景：尿液培养是检测和鉴定尿液中细菌的金标准，是许多微生物实验室中容量最大的测试之一。无法准确预测哪些患者将从培养中受益不仅会导致实验室资源的垄断，还会导致患者在等待培养结果时接受疑似或推定尿路感染 (UTI) 的经验性治疗，从而导致不必要的抗菌药物暴露。减少不必要的尿培养的常见方法是使用尿液分析 (UA) 参数筛选样本，以确定哪些样本应进行培养（反射）。在本研究中，我们比较了新型尿路病原体检测方法与尿液分析的性能，以进行 UTI 筛查。方法：通过尿液分析和能够检测尿液中细菌存在的新型光散射装置（BacterioScan 216Dx UTI 系统）对提交培养的尿液样本 (n = 194) 进行评估。 UA 和 216Dx 预测尿培养阳性的敏感性和特异性是根据尿培养结果确定的。尿培养阳性定义为培养物中一种或两种尿路病原体的生长浓度 >= 50,000 CFU/mL。结果：通过 UA、216Dx 和尿培养对 194 份尿样进行了评估。 216Dx 在检测菌尿方面表现出 100% [95%CI: 88.43%-100.0%] 的敏感性和 81.71% [95%CI: 74.93%-87.30%] 的特异性，而 UA 的敏感性为 86.67% [95%CI 69.28%-96.24%]，特异性为与尿培养（诊断参考方法）相比，为 71.95% [95%CI: 64.41%-78.68%]。结论：BacterioScan 提供了一种替代筛查方法，具有令人满意的灵敏度和更高的特异性，可能有助于减少不必要的培养。需要进行更多研究来确定 216Dx 技术是否可以同时减少不适当的抗生素使用。
Background: Urine culture, the gold standard for detecting and identifying bacteria in urine, is one of the highest volume tests in many microbiology laboratories. The inability to accurately predict which patients would benefit from culture leads not only to monopolization of laboratory resources, but also to unnecessary antimicrobial exposure as patients receive empirical treatment for suspected or presumed urinary tract infections (UTI) while awaiting culture results. A common approach to decrease unnecessary urine culture is screening samples using urinalysis (UA) parameters to determine those that should proceed to culture (reflex). In this study, we compared the performance of a novel uropathogen detection method to urinalysis for purposes of UTI screening.Methods: Urine specimens submitted for culture (n = 194) were evaluated by urinalysis and a novel light scattering device (BacterioScan 216Dx UTI System) capable of detecting the presence of bacteria in urine. Sensitivity and specificity for prediction of a positive urine culture by UA and 216Dx were determined relative to urine culture results. A positive urine culture was defined as growth in culture of one or two uropathogens at concentrations of >= 50,000 CFU/mL.Results: 194 urine samples were evaluated by UA, 216Dx, and urine culture. The 216Dx demonstrated a 100% [95%CI: 88.43%-100.0%] sensitivity and 81.71% [95%CI: 74.93%-87.30%] specificity for the detection of bacteriuria, vs UA with a sensitivity of 86.67% [95%CI 69.28%-96.24%] and specificity of 71.95% [95%CI: 64.41%-78.68%] when compared to urine culture (diagnostic reference method).Conclusions: BacterioScan allows for an alternative method of screening with satisfactory sensitivity and improved specificity that may facilitate a reduction of unnecessary cultures. Additional studies are required to determine if a concomitant decrease in inappropriate antibiotic use can be realized with the 216Dx technology.