Jameson Molly, Edmunds Otter Mary, Williams Christopher, Modha Deborah, Lim Felicia, Conroy Simon P
Department of Health Sciences, University of Leicester, George Davies Centre, Room 3.37, University Road, Leicester, LE1 7RH, UK.
Department of Microbiology, University Hospitals of Leicester, Leicester, UK.
Eur Geriatr Med. 2019 Oct;10(5):707-720. doi: 10.1007/s41999-019-00222-z. Epub 2019 Aug 22.
The aim of this study was to map out the existing knowledge on near-patient tests for urinary tract infections, and use a consensus building approach to identify those which might be worthy of further evaluation in the urgent care context, defined as clinically useful and feasible results available within 4-24 h.
A systematic search for reviews describing diagnostic tests for UTI was undertaken in Medline, EMBASE, Cochrane database of systematic reviews and CINAHL selected reviews were retained according to a priori inclusion and exclusion criteria, and then graded for quality using the CASP tool for reviews. A consensus process involving microbiologists and chemical pathologists helped identify which test might conceivably be applied in the urgent care context (e.g. Emergency Department, giving results within 24 h).
The initial search identified 1079 papers, from which 26 papers describing 35 diagnostic tests were retained for review. The overall quality was limited, with only 7/26 retained papers scoring more than 50% on the CASP criteria. Reviews on urine dipstick testing reported wide confidence intervals for sensitivity and specificity; several raised concerns about urine dip testing in older people. A number of novel biomarkers were reported upon but appeared not to be helpful in differentiating infection from asymptomatic bacteriuria. Blood markers such as CRP and procalcitonin were reported to be helpful in monitoring rather than diagnosing UTI. The consensus process helped to refine the 35 test down to 17 that might be useful in the urgent care context: urinalysis (nitrites and leucocytes), uriscreen catalase test, lactoferrin, secretory immunoglobulin A, xanthine oxidase, soluble triggering receptor expressed on myeloid cells, A-1 microglobulin (a1 Mg) and a1 Mg/creatinine ratio, cytokine IL-6, RapidBac, MALDI-TOF, electronic noses, colorimetric sensor arrays, electro chemical biosensor, WBC count (blood), C-reactive peptide, erythrocyte sedimentation rate.
A wide range of diagnostic tests have been explored to diagnose UTI, but, in general, have been poorly evaluated or have wide variation in predictive properties. This study identified 17 tests for UTI that seemed to offer some primes and merit further evaluation for diagnosing UTI in older people in urgent care settings.
本研究旨在梳理有关尿路感染即时检验的现有知识，并采用共识构建方法来确定那些在紧急护理环境中可能值得进一步评估的检验方法，紧急护理环境定义为在4 - 24小时内可获得临床有用且可行的结果。
在Medline、EMBASE、Cochrane系统评价数据库和CINAHL中对描述尿路感染诊断检验的综述进行系统检索。根据事先确定的纳入和排除标准保留选定的综述，然后使用用于综述的CASP工具对质量进行分级。一个由微生物学家和临床病理学家参与的共识过程有助于确定哪些检验可能适用于紧急护理环境（如急诊科，在24小时内给出结果）。
初步检索识别出1079篇论文，从中保留了26篇描述35种诊断检验的论文进行综述。总体质量有限，在26篇保留论文中，只有7篇在CASP标准上得分超过50%。关于尿试纸检测的综述报告了敏感性和特异性的宽泛置信区间；一些综述对老年人的尿试纸检测提出了担忧。报告了一些新型生物标志物，但似乎无助于区分感染与无症状菌尿。据报道，诸如CRP和降钙素原等血液标志物有助于监测而非诊断尿路感染。共识过程有助于将35种检验精简至17种，这些检验可能在紧急护理环境中有用：尿液分析（亚硝酸盐和白细胞）、尿液筛选过氧化氢酶试验、乳铁蛋白、分泌型免疫球蛋白A、黄嘌呤氧化酶、髓系细胞上表达的可溶性触发受体、A - 1微球蛋白（a1Mg）和a1Mg/肌酐比值、细胞因子IL - 6、RapidBac、基质辅助激光解吸电离飞行时间质谱、电子鼻、比色传感器阵列、电化学生物传感器、白细胞计数（血液）、C反应蛋白、红细胞沉降率。
已经探索了多种诊断检验方法来诊断尿路感染，但总体而言，评估不佳或预测特性差异很大。本研究确定了17种尿路感染检验方法，这些方法似乎具有一些优势，值得在紧急护理环境中对老年人尿路感染的诊断进行进一步评估。
