Coudert M, Pépin M, de Thezy A, Fercot E, Laycuras M, Coudert A-L, Duran C, Bouchand F, Davido B, Le Crane M, Denis B, Muller F, Gourdon M, Peng C-L, Mahamdia R, Mekerta Z, Seridi Z, Gaillard J-L, Leichowski L, Moulias S, Rottman M, Sivadon-Tardy V, Teillet L, Dinh A
Unité de court séjour gériatrique, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
Soins de suite et rééducation gériatrique, hôpital Sainte-Périne, AP-HP, 11, rue Chardon-Lagache, 75016 Paris, France.
Rev Med Interne. 2019 Nov;40(11):714-721. doi: 10.1016/j.revmed.2019.06.010. Epub 2019 Jul 10.
Urinary tract infections (UTI) are the second cause of community-acquired bacterial infections in the elderly. Distinguishing symptomatic UTI from asymptomatic bacteriuria is problematic, as older adults are less likely to present with localized urinary symptoms. We evaluated characteristics of patients presenting UTI among elderly with sepsis. Moreover, we aimed to evaluate the sensibility and specificity of urine dipstick tests in the diagnosis of UTI in geriatric population.
We led a prospective, monocentric, observational study between April 2017 and January 2018. We included patients hospitalized in geriatric wards, who were prescribed urine culture for UTI symptoms or/and infection without primary sites for which a urine culture was prescribed. Dipstick urinalyses were performed for all patients. Clinical and biological characteristics of all patients were compared according to the final diagnosis of UTI. Moreover, results of dipstick tests were evaluated for the diagnosis of UTI in this population.
Among 165 patients, 67 (40.6 %) had a UTI and 98 (59.4 %) had another diagnosis. These two groups were comparable for age and daily-living activities. In the UTI group, the proportion of women was higher than in the other group (P<0.05), and mean MMSE score was lower (P<0.05). Positive urine dipstick test for leukocytes and/or nitrites had high sensitivity (92 %), but low specificity (50 %). Negative predictive value of this test was high (91 %).
For suspicion of UTI among elderly, few criteria are specific. Negative dipstick tests can suggest an absence of UTI due to its high negative predictive value.
尿路感染（UTI）是老年人社区获得性细菌感染的第二大原因。区分有症状的UTI和无症状菌尿存在困难，因为老年人出现局部泌尿系统症状的可能性较小。我们评估了老年脓毒症患者中出现UTI的患者特征。此外，我们旨在评估尿试纸条检测在老年人群UTI诊断中的敏感性和特异性。
我们在2017年4月至2018年1月期间开展了一项前瞻性、单中心观察性研究。我们纳入了老年病房住院的患者，这些患者因UTI症状或/和无原发部位的感染而接受尿培养。对所有患者进行尿试纸条分析。根据UTI的最终诊断比较所有患者的临床和生物学特征。此外，评估尿试纸条检测结果在该人群UTI诊断中的价值。
165例患者中，67例（40.6%）患有UTI，98例（59.4%）有其他诊断。这两组在年龄和日常生活活动方面具有可比性。UTI组中女性比例高于另一组（P<0.05），且平均简易精神状态检查表（MMSE）评分较低（P<0.05）。白细胞和/或亚硝酸盐尿试纸条检测阳性具有高敏感性（92%），但特异性低（50%）。该检测的阴性预测值高（91%）。
对于怀疑患有UTI的老年人，很少有特异性标准。尿试纸条检测阴性因其高阴性预测值可提示无UTI。
