Hamid Muhammad Akhter, Afroz Ruqiya, Ahmed Uqba Nawaz, Nanthakumar Arrutran, Arulchelvan Atchaya, Salim Asim
Department of Paediatrics, Scarborough Health Network, Toronto, Ontario.
Department of Paediatrics, University of Toronto, Toronto, Ontario.
Paediatr Child Health. 2019 Jul 12;25(7):419-424. doi: 10.1093/pch/pxz074. eCollection 2020 Nov.
The study aimed to assess current practices of a community hospital for collection of urine sample when diagnosis of urinary tract infection (UTI) is suspected in children aged 0 to 36 months old.
An analysis of paediatric patients aged 0 to 36 months old was performed in two separate audits to assess the quality of urine sampling. The first, retrospective analysis comprised of urine collections techniques in a community hospital for diagnosis of UTI followed by an education intervention in which the hospital staff was briefed regarding the Canadian Paediatric Society (CPS) position statement for diagnosis and management of UTI. CPS recommendations were transposed using PowerPoint presentations, reminders at unit huddles, and other educational forums. Second audit was a prospective analysis which was conducted 6 months after the educations intervention.
Bagged sampling had higher sensitivity and lower specificity due to sample contamination, versus transurethral bladder catheterization and suprapubic aspiration. The first audit showed that while 66% of culture-positive urine sampling was performed via the bagging, only 26% those positive cultures were repeated before treatment. In the second audit, after educational intervention, 33% of culture-positive urine collection was done via the bagging method and repeat testing was done in 83% of positive results on a bagged sample before initiating treatment. The false-positive rate for the diagnosis of UTIs in the first and second audit was 65.7 and 60%, respectively.
Our study recognizes the flaws in community hospital practices in the diagnosis of UTI in children and validates the significance of educational intervention in improving health care.
本研究旨在评估一家社区医院在怀疑0至36个月大儿童患有尿路感染（UTI）时采集尿液样本的现行做法。
在两项独立的审计中对0至36个月大的儿科患者进行分析，以评估尿液采样的质量。第一次是回顾性分析，包括社区医院诊断UTI时的尿液采集技术，随后进行了一次教育干预，向医院工作人员介绍了加拿大儿科学会（CPS）关于UTI诊断和管理的立场声明。通过PowerPoint演示文稿、科室会议提醒和其他教育论坛传达了CPS的建议。第二次审计是前瞻性分析，在教育干预6个月后进行。
由于样本污染，与经尿道膀胱插管和耻骨上穿刺抽吸相比，袋装采样具有更高的敏感性和更低的特异性。第一次审计显示，虽然66%的培养阳性尿液采样是通过袋装进行的，但在治疗前只有26%的阳性培养样本进行了重复检测。在第二次审计中，经过教育干预后，33%的培养阳性尿液采集是通过袋装方法进行的，并且在开始治疗前，83%的袋装样本阳性结果进行了重复检测。第一次和第二次审计中UTI诊断的假阳性率分别为65.7%和60%。
我们的研究认识到社区医院在儿童UTI诊断方面的做法存在缺陷，并证实了教育干预对改善医疗保健的重要性。
