Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Germany.
Dtsch Arztebl Int. 2010 May;107(21):361-7. doi: 10.3238/arztebl.2010.0361. Epub 2010 May 28.
Urinary tract infections (UTI) are among the leading reasons for treatment in adult primary care medicine, accounting for a considerable percentage of antibiotic prescriptions. Because this problem is so common and so significant in routine clinical practice, a high level of diagnostic accuracy is essential. Antibiotics should not be prescribed excessively, particularly in view of the increasing prevalence of antibiotic resistance.
Systematic review of relevant articles that were retrieved by a search of the Medline, Embase, and Cochrane Library databases. The recommendations of selected international guidelines were also taken into account, as were the German national quality standards for microbiological diagnosis.
The diagnosis of UTI by clinical criteria alone has an error rate of approximately 33%. The use of refined diagnostic algorithms does not completely eliminate uncertainty.
With the aid of a small number of additional diagnostic criteria, antibiotic treatment for UTI can be provided more specifically and thus more effectively. Differentiating UTI from asymptomatic bacteriuria, which usually requires no treatment, can lower the frequency of unnecessary antibiotic prescriptions.
尿路感染（UTI）是成人初级保健医学中治疗的主要原因之一，占抗生素处方的相当大比例。由于这个问题在常规临床实践中非常普遍且重要，因此需要高度的诊断准确性。不应该过度开具抗生素，特别是鉴于抗生素耐药性的日益普遍。
通过对 Medline、Embase 和 Cochrane Library 数据库的检索，对相关文章进行系统评价。还考虑了选定的国际指南建议以及德国微生物诊断的国家质量标准。
仅根据临床标准诊断 UTI 的错误率约为 33%。使用精制的诊断算法并不能完全消除不确定性。
借助少数其他诊断标准，可以更具体地提供针对 UTI 的抗生素治疗，从而更有效地治疗 UTI。区分需要治疗的 UTI 和通常不需要治疗的无症状菌尿症可以降低不必要的抗生素处方的频率。
