Blue A P, Gordon D L
Department of Microbiology, Repatriation General Hospital, Daw Park.
Pathology. 1991 Apr;23(2):149-52. doi: 10.3109/00313029109060815.
One thousand eight hundred urine specimens were examined prospectively to determine the validity of primary sensitivity testing. Microscopic criteria assessing pyuria and microorganisms were developed for predicting the presence of urinary tract infection and thus suitability for direct sensitivity testing. The criteria selected gave a positive predictive value of 74.6% and a negative predictive value of 99.5%. Zone diameters by primary and standardized secondary methods were compared for each urinary pathogen to each antibiotic tested. Percentage agreement between primary and secondary sensitivity results varied between 100% for Enterobacteriaceae tested against Gentamicin to 95.2% for Enterococcus faecalis tested against Ampicillin. Seventeen discrepancies between primary and secondary test results were observed (error 2.0%) with only 3 of potential clinical significance (primary sensitive, secondary resistant). Although primary sensitivity testing has limitations, our study indicates that the results are, in the vast majority of cases, in agreement with secondary testing, and are probably adequate for the clinical management of uncomplicated urinary tract infections. Furthermore, as primary testing rarely produces false resistant results it may permit earlier modification of initial empiric therapy.
前瞻性地检查了1800份尿液标本，以确定初步药敏试验的有效性。制定了评估脓尿和微生物的微观标准，用于预测尿路感染的存在，从而判断是否适合直接进行药敏试验。所选择的标准给出了74.6%的阳性预测值和99.5%的阴性预测值。将每种尿路病原体对每种测试抗生素的初步和标准化二次药敏试验的抑菌圈直径进行了比较。初步和二次药敏结果之间的百分比一致性在针对庆大霉素测试的肠杆菌科为100%，针对氨苄西林测试的粪肠球菌为95.2%之间变化。观察到初步和二次测试结果之间有17处差异（误差2.0%），其中只有3处具有潜在临床意义（初步药敏敏感，二次药敏耐药）。虽然初步药敏试验有局限性，但我们的研究表明，在绝大多数情况下，结果与二次试验一致，可能足以用于单纯性尿路感染的临床管理。此外，由于初步试验很少产生假耐药结果，它可能允许更早地调整初始经验性治疗。
