Goldsmith B M, Campos J M
Department of Laboratory Medicine, Children's National Medical Center, Washington, D.C.
Clin Pediatr (Phila). 1990 Apr;29(4):214-8. doi: 10.1177/000992289002900402.
The authors compared dipstick tests for leukocyte esterase and nitrite and microscopic examination of urinary sediment with urine culture to assess whether the former tests could reliably rule out bacteriuria in specimens from children. The authors studied urine specimens from 1010 infants and children younger than age 18. Compared with culture at greater than or equal to 10(5) colony forming units (cfu)/ml, the sensitivities of leukocyte esterase, nitrite, and microscopic examination of white blood cells (greater than or equal to 5 wbc/hpf) or bacteria (in at least moderate numbers) were 76 percent, 29 percent, 82 percent, and 80 percent, respectively. The specificities of the same tests were 81 percent, 99 percent, 81 percent, and 83 percent, respectively. Compared with culture at greater than or equal to 10(4) cfu/ml, the sensitivities of the tests were 64 percent, 21 percent, 64 percent, and 59 percent; the specificities were 82 percent, 99 percent, 81 percent, and 83 percent, respectively. The negative predictive values of leukocyte esterase and microscopic examinations of urinary sediment for white blood cells and bacteria were all 95 percent (greater than or equal to 10(4) cfu/ml) or 98 percent (greater than or equal to 10(5) cfu/ml). The authors conclude that the leukocyte esterase test is as accurate as sediment microscopy in identifying urine specimens from infants and children harboring less than 10(4) or less than 10(5) cfu/ml.
作者比较了用于检测白细胞酯酶和亚硝酸盐的试纸条检测以及尿沉渣显微镜检查与尿培养，以评估前两项检测能否可靠地排除儿童标本中的菌尿。作者研究了1010名18岁以下婴儿和儿童的尿液标本。与菌落形成单位（cfu）/毫升≥10⁵的培养结果相比，白细胞酯酶、亚硝酸盐以及白细胞显微镜检查（≥5个白细胞/高倍视野）或细菌（至少中等数量）的敏感性分别为76%、29%、82%和80%。相同检测的特异性分别为81%、99%、81%和83%。与cfu/毫升≥10⁴的培养结果相比，这些检测的敏感性分别为64%、21%、64%和59%；特异性分别为82%、99%、81%和83%。白细胞酯酶以及尿沉渣中白细胞和细菌显微镜检查的阴性预测值在cfu/毫升≥10⁴时均为95%，在cfu/毫升≥10⁵时均为98%。作者得出结论，在识别cfu/毫升低于10⁴或低于10⁵的婴儿和儿童尿液标本方面，白细胞酯酶检测与沉渣显微镜检查一样准确。
