Department of Public Health and Primary Care, Academic Centre for General Practice, EPI-Centre, KU Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK.
Fam Pract. 2022 Jul 19;39(4):616-622. doi: 10.1093/fampra/cmab118.
Early diagnosis of pediatrics urinary tract infections in the outpatient settings is challenging but essential to prevent hospitalization and kidney damage.
We aimed to evaluate the diagnostic test accuracy of a selection of point-of-care tests for pediatric urinary tract infections in general practice.
A prospective cross-sectional study in 26 general practices in Flanders, Belgium (clinicaltrials.gov, NCT03835104). Urine was sampled systematically from children between 3 months to 18 years presenting with an acute illness of maximum 10 days. Samples were analyzed at the central laboratory with a routine dipstick test, the Utriplex test, the Uriscreen test and the Rapidbac as index tests, and with urine culture showing more than 105 colony-forming units per milliliter of one pathogen as reference standard. For each test, we calculated sensitivity, specificity, positive and negative likelihood ratios, and predictive values with 95% confidence intervals.
Three-hundred urine samples were available for analysis of which 30 samples were culture positive (10%). Sensitivities and specificities were 32% (95% CI 16%-52%) and 86% (95% CI 82%-90%) for the dipstick test, 21% (95% CI 8%-40%) and 94% (95% CI 91%-97%) for the Utriplex test, 40% (95% CI 16%-68%) and 83% (95% CI 75%-88%) for the Rapidbac test, and 67% (95% CI 38%-88%) with 69% (95% CI 60%-76%) for the Uriscreen test.
All 4 point-of-care tests were suboptimal for use in the broad range of children presenting with acute illnesses to general practice. General practitioners need novel methods for obtaining reliable urine samples during the time of the consultation, especially for children not yet toilet-trained.
在门诊环境中早期诊断儿科尿路感染具有挑战性，但对于预防住院和肾损伤至关重要。
我们旨在评估在一般实践中用于儿科尿路感染的一组即时检测的诊断测试准确性。
在比利时佛兰德的 26 家普通诊所进行前瞻性横断面研究（clinicaltrials.gov，NCT03835104）。从患有 10 天以内急性疾病的 3 个月至 18 岁儿童中系统采集尿液样本。在中央实验室使用常规尿试纸检测、Utriplex 检测、Uriscreen 检测和 Rapidbac 作为指标检测，用尿液培养显示每毫升超过 105 个菌落形成单位的一种病原体作为参考标准进行样本分析。对于每种检测，我们计算了敏感性、特异性、阳性和阴性似然比以及预测值，置信区间为 95%。
可分析 300 份尿液样本，其中 30 份样本培养阳性（10%）。尿试纸检测的敏感性和特异性分别为 32%（95%CI 16%-52%）和 86%（95%CI 82%-90%），Utriplex 检测分别为 21%（95%CI 8%-40%）和 94%（95%CI 91%-97%），Rapidbac 检测分别为 40%（95%CI 16%-68%）和 83%（95%CI 75%-88%），Uriscreen 检测分别为 67%（95%CI 38%-88%）和 69%（95%CI 60%-76%）。
在广泛的患有急性疾病就诊于普通诊所的儿童中，所有 4 种即时检测均不理想。普通医生需要在就诊期间获得可靠尿液样本的新方法，尤其是对于尚未接受如厕训练的儿童。
