即时检测亚硝酸盐和白细胞酯酶试纸用于筛查儿科尿路感染的诊断准确性。

Diagnostic Accuracy of Point-of-care Nitrite and Leukocyte Esterase Dipstick Test for the Screening of Pediatric Urinary Tract Infections.

机构信息

Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

出版信息

Saudi J Kidney Dis Transpl. 2021 May-Jun;32(3):703-710. doi: 10.4103/1319-2442.336765.

DOI:10.4103/1319-2442.336765

PMID:35102912

Abstract

Our study aimed to evaluate the diagnostic performance of point-of-care nitrite and leukocyte esterase (LE) dipsticks in the diagnosis of suspected urinary tract infection (UTI) in infants <6 months (young infants) versus older children. The secondary objectives were to study the dipstick efficacy in children with congenital anomalies of the kidney and urinary tract (CAKUT) versus those without CAKUT; in children with simple UTI versus complicated UTI; and to evaluate the clinico-microbiological profile of children presenting with UTI. In this prospective observational study, cases with suspected UTI were enrolled from pediatric emergency or outpatient departments. Urine was collected for performing the urine dipstick and culture. Descriptive data regarding CAKUT, age, gender, etc., were recorded in a predesigned pro forma. We screened 506 children with suspected UTI, of whom 221 had urine culture positive. Approximately 38.4% of the children with UTI had underlying CAKUT, while 7.6% had renal scars. The most common CAKUT was vesicoureteric reflux (VUR). About 12 patients (2.3%) were known to have CAKUT at the time of enrollment in the study. In infants <6 months, LE dipstick had sensitivity 92%, specificity 89.7%, positive predictive value (PPV) 86.7%, negative predictive value (NPV) 93.8%, likelihood ratio (LR) + 8.9, LR- 0.09. In infants <6 months, nitrite dipstick had sensitivity 38%, specificity 97%, PPV 90.4%, NPV 68%, LR+ 12.6 and LR-0.63. In the age group 6 months to 12 years, the efficacy was better for both dipsticks. In age group more than 6 months to 12 years, LE dipstick had sensitivity 96.4%, specificity 95.8%, PPV 94.8 %, NPV 97.2%, LR+ 22.9, LR- 0.04. In age group more than six months to 12 years, nitrite dipstick had sensitivity 94.7%, specificity 99.5%, PPV 99.3%, NPV 96%, LR+ 189.4, and LR-0.05.

摘要

我们的研究旨在评估即时尿液亚硝酸盐和白细胞酯酶（LE）检测试条在诊断 6 个月以下（婴幼儿）和较大儿童疑似尿路感染（UTI）中的诊断性能。次要目标是研究试条在患有先天性肾和尿路异常（CAKUT）和无 CAKUT 的儿童中的效果；在单纯性 UTI 和复杂性 UTI 儿童中的效果；并评估出现 UTI 的儿童的临床微生物学特征。在这项前瞻性观察研究中，从儿科急诊或门诊部门招募疑似 UTI 的病例。采集尿液进行尿液试条和培养。在预先设计的表格中记录有关 CAKUT、年龄、性别等的描述性数据。我们筛查了 506 例疑似 UTI 的儿童，其中 221 例尿液培养阳性。大约 38.4%的 UTI 患儿有潜在的 CAKUT，而 7.6%有肾瘢痕。最常见的 CAKUT 是膀胱输尿管反流（VUR）。约有 12 名患者（2.3%）在入组研究时已知有 CAKUT。在 6 个月以下的婴儿中，LE 试条的敏感性为 92%，特异性为 89.7%，阳性预测值（PPV）为 86.7%，阴性预测值（NPV）为 93.8%，阳性似然比（LR）为 8.9，LR-为 0.09。在 6 个月以下的婴儿中，亚硝酸盐试条的敏感性为 38%，特异性为 97%，PPV 为 90.4%，NPV 为 68%，LR+为 12.6，LR-为 0.63。在 6 个月至 12 岁年龄组中，两种试条的效果都更好。在 6 个月至 12 岁年龄组中，LE 试条的敏感性为 96.4%，特异性为 95.8%，PPV 为 94.8%，NPV 为 97.2%，LR+为 22.9，LR-为 0.04。在 6 个月至 12 岁年龄组中，亚硝酸盐试条的敏感性为 94.7%，特异性为 99.5%，PPV 为 99.3%，NPV 为 96%，LR+为 189.4，LR-为 0.05。