University of Melbourne, Parkville, Victoria, Australia.
Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria, Australia.
Support Care Cancer. 2019 Apr;27(4):1223-1227. doi: 10.1007/s00520-018-4476-7. Epub 2018 Sep 27.
There is a paucity of data regarding the utility of routine urine cultures in adults with febrile neutropenia (FN) without urinary symptoms receiving protocolised antibiotics. This is reflected by inconsistent recommendations in international and regional FN guidelines. We addressed this issue by retrospectively reviewing the impact of routine urine cultures on antibiotic management in haematology cancer inpatients at a tertiary hospital.
All haematology inpatients over a 5-year period (2011-2015) were retrospectively reviewed for episodes of FN (neutrophil count < 0.5 × 10/L and fever > 37.5 °C). For each episode, demographic data, urinary tract symptoms and signs (absence of which was termed 'asymptomatic'), urinalysis and urine culture results, antibiotic therapy and duration, and patient outcomes were collected. A urine culture was considered positive if > 10 colony forming units (CFU)/L were detected. Empiric antibiotic therapy for FN consisted of intravenous piperacillin/tazobactam in stable patients, with the addition of vancomycin and a single dose of gentamicin if systemically compromised.
Four hundred and thirty-three episodes of FN were identified in 317 patients. Urine cultures were performed in 362 (84%) episodes. Cultures were positive in 9 of 48 (19%) symptomatic episodes versus 8 of 314 (2.5%) asymptomatic episodes (RR = 7.4, p < 0.0001). A change in antibiotic management due a positive urine culture occurred in only 5 episodes (1.4%): 3 of 48 (6.3%) symptomatic and 2 of 314 (0.6%) asymptomatic episodes respectively (RR = 9.8, p = 0.01).
Routine urine cultures in FN patients without urinary symptoms who are already receiving protocolised broad spectrum antibiotics rarely impact subsequent antibiotic management.
在接受既定抗生素方案治疗、无尿路症状的发热性中性粒细胞减少症（FN）成人中，常规尿培养对其的作用数据很少。这反映了国际和地区 FN 指南中的推荐意见不一致。我们通过回顾性分析三级医院血液科癌症住院患者 FN 时常规尿培养对抗生素管理的影响来解决这个问题。
回顾性分析了 5 年（2011-2015 年）期间所有血液科住院患者 FN 发作的病例（中性粒细胞计数 < 0.5×10/L 和发热 > 37.5°C）。对于每个病例，收集了人口统计学数据、尿路症状和体征（无症状）、尿液分析和尿液培养结果、抗生素治疗和持续时间以及患者结局。如果检测到 > 10 个菌落形成单位（CFU）/L，则认为尿液培养阳性。FN 的经验性抗生素治疗包括稳定患者的静脉注射哌拉西林/他唑巴坦，如果全身情况恶化，则加用万古霉素和单次剂量的庆大霉素。
在 317 名患者中，共发现 433 例 FN 发作。362 例（84%）进行了尿液培养。48 例有症状的发作中有 9 例（19%）尿液培养阳性，314 例无症状的发作中有 8 例（2.5%）尿液培养阳性（RR=7.4，p<0.0001）。仅 5 例（1.4%）因阳性尿液培养而改变抗生素治疗：3 例为 48 例有症状的发作，2 例为 314 例无症状的发作（RR=9.8，p=0.01）。
对于已经接受既定广谱抗生素方案治疗、无尿路症状的 FN 患者，常规尿培养很少会影响后续抗生素管理。
