Suppr超能文献

3个月龄以下婴儿尿路感染尿液分析的诊断准确性

Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3 months of age.

作者信息

Schroeder Alan R, Chang Pearl W, Shen Mark W, Biondi Eric A, Greenhow Tara L

机构信息

Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California;

Department of Pediatrics, Kaiser Permanente Northern California, Oakland, California;

出版信息

Pediatrics. 2015 Jun;135(6):965-71. doi: 10.1542/peds.2015-0012.

Abstract

BACKGROUND

The 2011 American Academy of Pediatrics urinary tract infection (UTI) guideline suggests incorporation of a positive urinalysis (UA) into the definition of UTI. However, concerns linger over UA sensitivity in young infants. Infants with the same pathogenic organism in the blood and urine (bacteremic UTI) have true infections and represent a desirable population for examination of UA sensitivity.

METHODS

We collected UA results on a cross-sectional sample of 276 infants <3 months of age with bacteremic UTI from 11 hospital systems. Sensitivity was calculated on infants who had at least a partial UA performed and had ≥50 000 colony-forming units per milliliter from the urine culture. Specificity was determined by using a random sample of infants from the central study site with negative urine cultures.

RESULTS

The final sample included 245 infants with bacteremic UTI and 115 infants with negative urine cultures. The sensitivity of leukocyte esterase was 97.6% (95% confidence interval [CI] 94.5%-99.2%) and of pyuria (>3 white blood cells/high-power field) was 96% (95% CI 92.5%-98.1%). Only 1 infant with bacteremic UTI (Group B Streptococcus) and a complete UA had an entirely negative UA. In infants with negative urine cultures, leukocyte esterase specificity was 93.9% (95% CI 87.9 - 97.5) and of pyuria was 91.3% (84.6%-95.6%).

CONCLUSIONS

In young infants with bacteremic UTI, UA sensitivity is higher than previous reports in infants with UTI in general. This finding can be explained by spectrum bias or by inclusion of faulty gold standards (contaminants or asymptomatic bacteriuria) in previous studies.

摘要

背景

2011年美国儿科学会泌尿道感染(UTI)指南建议将尿常规检查(UA)呈阳性纳入UTI的定义中。然而,对于小婴儿尿常规检查的敏感性仍存在担忧。血和尿中存在相同致病微生物的婴儿(菌血症性UTI)存在真正的感染,是检查尿常规敏感性的理想人群。

方法

我们收集了来自11个医院系统的276例3个月以下菌血症性UTI婴儿的横断面样本的尿常规结果。对至少进行了部分尿常规检查且尿培养每毫升菌落形成单位≥50000的婴儿计算敏感性。通过使用来自中心研究地点尿培养阴性的婴儿随机样本确定特异性。

结果

最终样本包括245例菌血症性UTI婴儿和115例尿培养阴性的婴儿。白细胞酯酶的敏感性为97.6%(95%置信区间[CI]94.5%-99.2%),脓尿(>3个白细胞/高倍视野)的敏感性为96%(95%CI92.5%-98.1%)。只有1例菌血症性UTI婴儿(B族链球菌)且进行了完整尿常规检查,其尿常规完全阴性。在尿培养阴性的婴儿中,白细胞酯酶特异性为93.9%(95%CI87.9-97.5),脓尿特异性为91.3%(84.6%-95.6%)。

结论

在患有菌血症性UTI的小婴儿中,尿常规敏感性高于既往一般UTI婴儿的报告。这一发现可通过谱偏倚或既往研究中纳入错误的金标准(污染物或无症状菌尿)来解释。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验