即时尿液革兰氏染色有助于对青少年和成人发热性尿路感染进行更窄谱的抗菌药物选择。
Point-of-care urine Gram stain led to narrower-spectrum antimicrobial selection for febrile urinary tract infection in adolescents and adults.
机构信息
Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan.
Division of General Internal Medicine and Infectious Diseases, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minamiku, Hiroshima, 734-8530, Japan.
出版信息
BMC Infect Dis. 2022 Mar 1;22(1):198. doi: 10.1186/s12879-022-07194-9.
BACKGROUND
Febrile urinary tract infections (fUTIs), which include pyelonephritis, prostatitis, and urosepsis, are the most common cause of sepsis. However, the treatment has become more complex because of the worldwide increase in antimicrobial resistance (AMR). The objective of this study was to clarify whether point-of-care Gram stain (PCGS) of urine contributed to fUTI diagnosis and treatment in adults.
METHODS
This hospital-based observational study was undertaken between January 2013 and March 2015 in Okinawa, Japan. All enrolled patients were adults who had been admitted to the Division of Infectious Diseases with suspected fUTI. The usefulness of PCGS results were compared for urinalysis (U/A) and urine cultures (U/Cs). The targeted therapy type and its susceptibility based on PCGS were analyzed, and each was investigated in two groups: the uncomplicated pyelonephritis group and the complicated pyelonephritis/prostatitis group.
RESULTS
Two hundred and sixty-six patients were enrolled. The results of PCGS were closely correlated with those of U/A for pyuria and bacteriuria, and moderately correlated with the results of U/C for bacterial types. In the uncomplicated group, narrow-spectrum antimicrobials such as cefotiam were initially selected in 97.9% (47/48) of patients, and their susceptibility was 97.9% (47/48). In the complicated group, the susceptibility was 84.2% (186/221) (p = 0.009) despite frequent AMRs (14.7%; 32/218) and low use of broad-spectrum antimicrobials such as carbapenems (7.7%; 17/221).
CONCLUSION
Urine PCGS led to a more precise fUTI diagnosis and prompted clinicians to select narrower-spectrum antibiotics with high susceptibility.
背景
发热性尿路感染（fUTI）包括肾盂肾炎、前列腺炎和脓毒症，是败血症最常见的原因。然而，由于全球范围内抗菌药物耐药性（AMR）的增加，治疗变得更加复杂。本研究的目的是阐明即时尿液革兰氏染色（PCGS）是否有助于成人 fUTI 的诊断和治疗。
方法
这是一项在日本冲绳进行的基于医院的观察性研究，时间为 2013 年 1 月至 2015 年 3 月。所有纳入的患者均为因疑似 fUTI 而被收入传染病科的成年人。比较了 PCGS 结果对尿液分析（U/A）和尿液培养（U/Cs）的有用性。分析了基于 PCGS 的靶向治疗类型及其敏感性，并在两组中进行了研究：单纯性肾盂肾炎组和复杂性肾盂肾炎/前列腺炎组。
结果
共纳入 266 例患者。PCGS 的结果与 U/A 的脓尿和菌尿结果密切相关，与 U/C 的细菌类型结果中度相关。在单纯性组中，97.9%（47/48）的患者最初选择了窄谱抗生素如头孢替安，其敏感性为 97.9%（47/48）。在复杂性组中，尽管经常出现 AMR（14.7%，32/218）和广谱抗生素如碳青霉烯类药物的使用率较低（7.7%，17/221），但敏感性为 84.2%（186/221）（p=0.009）。
结论
尿液 PCGS 可更准确地诊断 fUTI，并促使临床医生选择具有高敏感性的更窄谱抗生素。
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