留置导尿管患者脓尿与感染的关系：761例患者的前瞻性研究

The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients.

作者信息

Tambyah P A, Maki D G

机构信息

Department of Medicine, University of Wisconsin Medical School, Madison, USA.

出版信息

Arch Intern Med. 2000 Mar 13;160(5):673-7. doi: 10.1001/archinte.160.5.673.

DOI:10.1001/archinte.160.5.673

PMID:10724053

Abstract

BACKGROUND

Pyuria is universally considered as essential for identifying urinary tract infections in noncatheterized patients. The utility of pyuria in the catheterized patient, to identify catheter-associated urinary tract infection (CAUTI), has not been adequately defined.

METHODS

We prospectively studied 761 newly catheterized patients in a university hospital; 82 (10.8%) developed nosocomial CAUTI (> 10(3) colony-forming units per milliliter). While catheterized, each patient was seen daily, a quantitative urine culture was obtained, and the urine white blood cell concentration was measured quantitatively using a hemocytometer.

RESULTS

The mean urine leukocyte count in patients with CAUTI was significantly higher than in patients without infections (71 vs 4 per microliter; P= .006). Pyuria was most strongly associated with CAUTI caused by gram-negative bacilli (white blood cell count, 121 vs 4 per microliter; P = .03); infection with coagulase-negative staphylococci and enterococci (white blood cell count, 39 vs 4 per microliter; P = .25) or yeasts (white blood cell count, 25 vs 4 per microliter; P = .15) produced much less pyuria. Pyuria with a white blood cell count greater than 10 per microliter (>5 per high-power field in a conventional urinalysis) had a specificity of 90% for predicting CAUTI with greater than 10(5) colony-forming units per milliliter but a sensitivity of only 37%.

CONCLUSIONS

In patients with short-term indwelling urinary catheters, pyuria is less strongly correlated with CAUTI than in noncatheterized patients with urinary tract infection. The strongest association is with CAUTI caused by gram-negative bacilli; the association is far weaker for infections caused by gram-positive cocci or yeasts. Most patients with CAUTI are asymptomatic and do not have associated fever. Pyuria should not be used as the sole criterion to obtain a urine culture in a patient with a catheter.

摘要

背景

脓尿普遍被认为是识别非导尿患者尿路感染的必要条件。脓尿在导尿患者中用于识别导管相关尿路感染（CAUTI）的效用尚未得到充分界定。

方法

我们对一家大学医院的761例新留置导尿管的患者进行了前瞻性研究；82例（10.8%）发生了医院获得性CAUTI（每毫升>10³菌落形成单位）。在留置导尿管期间，每天对每位患者进行检查，进行定量尿培养，并使用血细胞计数器定量测量尿白细胞浓度。

结果

CAUTI患者的平均尿白细胞计数显著高于未感染患者（每微升71个对4个；P = 0.006）。脓尿与革兰氏阴性杆菌引起的CAUTI相关性最强（白细胞计数，每微升121个对4个；P = 0.03）；凝固酶阴性葡萄球菌和肠球菌感染（白细胞计数，每微升39个对4个；P = 0.25）或酵母菌感染（白细胞计数，每微升25个对4个；P = 0.15）产生的脓尿要少得多。白细胞计数大于每微升10个（传统尿液分析中每高倍视野>5个）的脓尿对于预测每毫升>10⁵菌落形成单位的CAUTI的特异性为90%，但敏感性仅为37%。