EPI-Centre, Academic Centre for General Practice, KU Leuven, Leuven, Belgium.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.
Acta Paediatr. 2021 Dec;110(12):3170-3179. doi: 10.1111/apa.16027. Epub 2021 Jul 17.
To investigate the diagnostic test accuracy of urine collection methods for urinary tract infections in outpatient children.
A systematic literature review until April 2021 (Medline, Web of Science, Embase, Cinahl) to examine the diagnostic test accuracy of urine culture on collection methods for urinary tract infection in outpatient children below 18 years. Contamination rates were studied as secondary outcome. The risk of bias was assessed using the QUADAS-2 criteria. Two-by-two tables were extracted in duplicate to calculate sensitivities, specificities, and likelihood ratios with 95% confidence intervals.
The search identified seven relevant studies. Clean catch compared to catheterization in children less than 90 days showed a sensitivity and specificity of 97% and 89% (95% CI: 84%-100% and 67%-99%), respectively. Adhesive bags compared to catheterization showed a sensitivity of 83% (95% CI: 75%-90%) and specificity of 91% (95% CI: 83%-96%). There was a similar diagnostic accuracy when comparing urine sampling by means of adhesive bags versus nappy pads. The contamination rate was 5% for clean catch, 30%-80% for adhesive bags and 64% for nappy pads.
Nappy pads and adhesive bags are easy to use with comparable accuracy but are extremely prone to contamination. Clean-catch urine sampling might be an accurate alternative in young infants in ambulatory care.
调查门诊儿童尿路感染尿液采集方法的诊断试验准确性。
系统检索截至 2021 年 4 月（Medline、Web of Science、Embase、Cinahl）的文献，以评估门诊 18 岁以下儿童尿路感染尿液采集方法的诊断试验准确性。以污染率为次要结局。采用 QUADAS-2 标准评估偏倚风险。提取双份 2×2 表以计算敏感度、特异度和比值比及其 95%置信区间。
检索共确定了 7 项相关研究。与导管法相比，小于 90 天的儿童采用清洁中段尿采集法的敏感度和特异度分别为 97%和 89%（95%CI：84%-100%和 67%-99%）。与导管法相比，采用粘性尿袋采集法的敏感度为 83%（95%CI：75%-90%），特异度为 91%（95%CI：83%-96%）。粘性尿袋与尿布垫采集尿液的诊断准确性相似。清洁中段尿采集法的污染率为 5%，粘性尿袋为 30%-80%，尿布垫为 64%。
与导管法相比，粘性尿袋和尿布垫使用方便，准确性相当，但极易污染。在门诊环境中，清洁中段尿采集法可能是婴幼儿的一种准确替代方法。
