Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
PLoS One. 2018 Feb 23;13(2):e0193255. doi: 10.1371/journal.pone.0193255. eCollection 2018.
Patients presenting with suspected urinary tract infection are common in every day emergency practice. Urine flow cytometry has replaced microscopic urine evaluation in many emergency departments, but interpretation of the results remains challenging. The aim of this study was to develop and validate tools that predict urine culture growth out of urine flow cytometry parameter.
This retrospective study included all adult patients that presented in a large emergency department between January and July 2017 with a suspected urinary tract infection and had a urine flow cytometry as well as a urine culture obtained. The objective was to identify urine flow cytometry parameters that reliably predict urine culture growth and mixed flora growth. The data set was split into a training (70%) and a validation set (30%) and different decision-making approaches were developed and validated.
Relevant urine culture growth (respectively mixed flora growth) was found in 40.2% (7.2% respectively) of the 613 patients included. The number of leukocytes and bacteria in flow cytometry were highly associated with urine culture growth, but mixed flora growth could not be sufficiently predicted from the urine flow cytometry parameters. A decision tree, predictive value figures, a nomogram, and a cut-off table to predict urine culture growth from bacteria and leukocyte count were developed, validated and compared.
Urine flow cytometry parameters are insufficient to predict mixed flora growth. However, the prediction of urine culture growth based on bacteria and leukocyte count is highly accurate and the developed tools should be used as part of the decision-making process of ordering a urine culture or starting an antibiotic therapy if a urogenital infection is suspected.
在日常急诊实践中，出现疑似尿路感染的患者较为常见。尿液流式细胞术已在许多急诊科取代了显微镜尿液评估，但结果的解释仍然具有挑战性。本研究的目的是开发和验证可预测尿液流式细胞术参数外的尿液培养物生长的工具。
本回顾性研究纳入了 2017 年 1 月至 7 月期间在一家大型急诊科就诊的所有疑似尿路感染且进行了尿液流式细胞术和尿液培养的成年患者。目的是确定可可靠预测尿液培养物生长和混合菌群生长的尿液流式细胞术参数。数据集分为训练集（70%）和验证集（30%），并开发和验证了不同的决策方法。
在纳入的 613 例患者中，分别有 40.2%（7.2%）出现了相关的尿液培养物生长（分别为混合菌群生长）。流式细胞术中白细胞和细菌数量与尿液培养物生长高度相关，但混合菌群生长不能通过尿液流式细胞术参数充分预测。开发、验证和比较了一种基于细菌和白细胞计数预测尿液培养物生长的决策树、预测值图、列线图和截断表。
尿液流式细胞术参数不足以预测混合菌群生长。然而，基于细菌和白细胞计数预测尿液培养物生长的准确性很高，在怀疑存在尿路感染时，应将所开发的工具作为是否进行尿液培养或开始抗生素治疗的决策过程的一部分。
