Tissot E, Woronoff-Lemsi M C, Cornette C, Plesiat P, Jacquet M, Capellier G
Department of Pharmacy, Besançon University Hospital, Boulevard Fleming, 25030 Besançon cedex, France.
Intensive Care Med. 2001 Dec;27(12):1842-7. doi: 10.1007/s00134-001-1134-0. Epub 2001 Nov 8.
To assess the cost-effectiveness of urinary dipsticks (UDs) to screen asymptomatic catheterized patients for quantitative urine.
Prospective comparison of UD with quantitative urine culture (QUC) (reference technique) and cost-effectiveness analysis performed from the hospital's perspective.
Medical intensive care unit (ICU) of the Besançon University Hospital (France).
All consecutive, asymptomatic, catheterized patients.
Urinary dipsticks (Multistix 8-SG) were analyzed by the reflectance spectrophotometric method (Clinitek 50). Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of four combinations of the leukocyte (L) test pad and the nitrite (N) test pad were calculated: L and N, L or N, L alone and N alone. A micro-costing technique was used to determine the direct medical cost of each strategy. The calculated cost-effectiveness ratio was the incremental cost-effectiveness (ICE) ratio.
Three hundred thirty-nine urine samples taken from 144 patients were analyzed. The incidence of asymptomatic catheter-associated urinary tract infections (CAUTIs) was 31.3% (> or =10(5) organisms/ml). The L or N combination was the best detector of asymptomatic CAUTI: Se=87.2%, Sp=61.6%, PPV=30.6% and NPV=96.1%. The cost of QUC strategy and UD strategy was EUR 21.5 and EUR 12.6 per test, respectively. The ICE ratio of QUCs was EUR 69.5 per case of detected CAUTI.
The UD is a cost-effective test for screening asymptomatic catheterized patients for quantitative urine culture in a medical ICU.
评估尿试纸条（UDs）用于筛查无症状导尿患者定量尿液的成本效益。
从医院角度对UD与定量尿培养（QUC）（参考技术）进行前瞻性比较并进行成本效益分析。
法国贝桑松大学医院的医学重症监护病房（ICU）。
所有连续的无症状导尿患者。
采用反射分光光度法（Clinitek 50）分析尿试纸条（Multistix 8-SG）。计算白细胞（L）测试垫和亚硝酸盐（N）测试垫四种组合的敏感性（Se）、特异性（Sp）、阳性预测值（PPV）和阴性预测值（NPV）：L和N、L或N、单独L和单独N。采用微观成本核算技术确定每种策略的直接医疗成本。计算的成本效益比为增量成本效益（ICE）比。
分析了从144例患者采集的339份尿液样本。无症状导尿管相关尿路感染（CAUTIs）的发生率为31.3%（≥10⁵ 个菌落形成单位/毫升）。L或N组合是无症状CAUTI的最佳检测方法：Se = 87.2%，Sp = 61.6%，PPV = 30.6%，NPV = 96.1%。QUC策略和UD策略的成本分别为每次检测21.5欧元和12.6欧元。检测到的每例CAUTI，QUC的ICE比为69.5欧元。
在医学ICU中，UD是一种用于筛查无症状导尿患者定量尿培养的具有成本效益的检测方法。
