Claeys Kimberly C, Blanco Natalia, Morgan Daniel J, Leekha Surbhi, Sullivan Kaede V
Infectious Diseases, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 N. Pine Street, Baltimore, MD, 21201, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Baltimore, MD, 21201, USA.
Curr Infect Dis Rep. 2019 Mar 5;21(4):11. doi: 10.1007/s11908-019-0668-7.
Urinary tract infections (UTIs), including catheter-associated UTIs, are among the most common bacterial infections in both inpatient and outpatient settings. Diagnosis of true UTI remains a clinical challenge, and excessive antimicrobial treatment of asymptomatic bacteriuria (ASB) or contaminated urine cultures is common.
Challenges with the appropriate diagnosis of UTIs include the lack of specific signs and symptoms, no definitive diagnostic criteria, high incidence of ASB, contamination of samples, and frequent lack of indications for ordering urine cultures. Promising interventions include education and feedback, indication requirements when ordering cultures, and use of reflex culture policies that limit urine cultures. Antimicrobial and diagnostic stewardship interventions can work synergistically to decrease ordering of urine cultures without clear indication and prevent excessive antimicrobial administration in patients without clearly defined UTI.
尿路感染（UTIs），包括导管相关尿路感染，是住院和门诊环境中最常见的细菌感染之一。真正的尿路感染的诊断仍然是一项临床挑战，对无症状菌尿（ASB）或污染的尿培养进行过度抗菌治疗很常见。
尿路感染的正确诊断面临的挑战包括缺乏特异性体征和症状、没有明确的诊断标准、ASB发病率高、样本污染以及经常缺乏进行尿培养的指征。有前景的干预措施包括教育与反馈、开培养医嘱时的指征要求以及采用限制尿培养的动态培养策略。抗菌和诊断管理干预措施可以协同作用，减少无明确指征的尿培养医嘱，并防止在未明确诊断为UTI的患者中过度使用抗菌药物。
