Hundley Andrew F, Onderdonk Andrew B, Greenberg James A
Departments of Obstetrics, Gynecology and Reproductive Biology and of Microbiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Reprod Med. 2003 Nov;48(11):853-7.
To assess the utility and expense of routine urine culture in women evaluated for preterm labor.
A retrospective study of 1,429 patients evaluated for preterm labor over a calendar year. Patients evaluated for preterm labor were identified using the hospital's admissions database and then cross-referenced with the hospital microbiology laboratory's database to identify those who had urine cultures sent as part of their evaluation. The charts of patients with a positive urine culture were further reviewed to evaluate the diagnosis and outcome.
Five hundred twelve urine cultures were sent for analysis of preterm labor, and 6 (1.2%) reported growth of > 100,000 colonies of a single bacterium. Of these 6 patients, 5 reported symptoms consistent with a urinary tract infection, while the 6th was asymptomatic. Fisher's exact test showed no clinical significance for a positive urine culture as a predictor of preterm delivery (P = .68). Sensitivity was 0.7% (95% CI, 0.0-4.3), and specificity was 98.6% (95% CI, 96.7-99.5). A cost difference of $29,676 existed between charges and reimbursements. A positive culture was not a significant risk factor for preterm delivery. The 1 patient who delivered preterm with a positive culture probably had cervical incompetence as the cause of preterm delivery.
The routine use of urine cultures in the assessment of preterm labor is costly and adds little value to obtaining a diagnosis except in the presence of specific complaints at our institution. Urine culture identified a single patient with asymptomatic bacteriuria being evaluated for preterm labor, and she probably had another etiology for her advanced cervical examination.
评估对因早产接受评估的女性进行常规尿培养的效用和费用。
对一历年中1429例因早产接受评估的患者进行回顾性研究。利用医院入院数据库确定因早产接受评估的患者，然后与医院微生物实验室数据库进行交叉对照，以确定那些在评估过程中进行了尿培养的患者。对尿培养阳性患者的病历进行进一步审查，以评估诊断和结局。
共送检了512份用于早产分析的尿培养样本，其中6份（1.2%）报告单一细菌菌落数>100,000。在这6例患者中，5例报告有与尿路感染相符的症状，而第6例无症状。费舍尔精确检验显示，尿培养阳性作为早产预测指标无临床意义（P = 0.68）。敏感性为0.7%（95%CI，0.0 - 4.3），特异性为98.6%（95%CI，96.7 - 99.5）。收费与报销之间存在29,676美元的费用差异。培养阳性不是早产的显著危险因素。1例培养阳性且早产的患者，早产原因可能是宫颈机能不全。
在评估早产时常规使用尿培养成本高昂，除了在本院有特定主诉的情况下，对诊断几乎没有增加价值。尿培养发现1例因早产接受评估的无症状菌尿患者，她宫颈检查进展可能另有病因。
