Al-Orifi F, McGillivray D, Tange S, Kramer M S
Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Quebec, Canada.
J Pediatr. 2000 Aug;137(2):221-6. doi: 10.1067/mpd.2000.107466.
To compare the risks of contaminated culture results and consequent adverse clinical outcomes in urine specimens obtained by "clean-voided" bag method versus catheterization.
Hospital-based cohort study of all children </=24 months with outpatient urine cultures (n = 7584) obtained from January 1993 to December 1995. Medical records were followed up for all children with contaminated culture results who had 1 or more additional cultures within 7 days of the original culture. Contamination rates of bag urine cultures from the emergency department and a pediatric test center were compared.
Contamination rates were 62.8% and 9.1% (P <.001) in bag versus catheter specimens, respectively. Contamination rates of bag urine specimens collected in the emergency department and pediatric test center were 56.4% versus 69. 25%, respectively. Of the 3440 contaminated urines, 132 (1.7%) resulted in 1 or more adverse clinical outcomes. Adjusted odds ratios (and 95% CI) for these outcomes in bag versus catheter specimens were as follows: 4.9 (2.3 to 10.5) for unnecessary recall, infinite for delayed diagnosis and treatment, 4.8 (1.8 to 12.4) for unnecessary treatment, 15.6 (2.1 to 116.8) for unnecessary prolonged treatment, 4.1 (1.4 to 12.1) for unnecessary radiologic investigation, and 12.4 (1.6 to 95.5) for unnecessary hospital admission.
The risks of the "noninvasive" bag urine culture appear to exceed its benefits.
比较采用“自然排尿”袋法与导尿法获取的尿液标本中培养结果受污染的风险以及由此导致的不良临床结局。
对1993年1月至1995年12月期间进行门诊尿培养的所有24个月及以下儿童(n = 7584)开展基于医院的队列研究。对培养结果受污染且在原始培养后7天内进行了1次或更多次额外培养的所有儿童的病历进行随访。比较了急诊科和儿科检测中心袋式尿培养的污染率。
袋式标本和导尿标本的污染率分别为62.8%和9.1%(P <.001)。急诊科和儿科检测中心收集的袋式尿标本污染率分别为56.4%和69.25%。在3440份受污染的尿液中,132份(1.7%)导致了1种或更多种不良临床结局。袋式标本与导尿标本中这些结局的校正比值比(及95%置信区间)如下:不必要召回为4.9(2.3至10.5),延迟诊断和治疗为无穷大,不必要治疗为4.8(1.8至12.4),不必要的长期治疗为15.6(2.1至116.8),不必要的放射学检查为4.1(1.4至12.1),不必要的住院为12.4(1.6至95.5)。
“非侵入性”袋式尿培养的风险似乎超过了其益处。