尿液检测与急诊科患者不适当使用抗生素及住院时间延长有关。
Urine testing is associated with inappropriate antibiotic use and increased length of stay in emergency department patients.
作者信息
Childers Richard, Liotta Ben, Brennan Jesse, Wang Phoebe, Kattoula Jacob, Tran Thien, Montilla-Guedez Henry, Castillo Edward M, Vilke Gary
机构信息
Department of Emergency Medicine, University of California, San Diego, San Diego, CA, United States.
出版信息
Heliyon. 2022 Oct 12;8(10):e11049. doi: 10.1016/j.heliyon.2022.e11049. eCollection 2022 Oct.
BACKGROUND
Exposing patients with a low probability of disease to diagnostic testing with poor test characteristics leads to false positive results. Providers often act on these false results, which can cause unnecessary evaluation and treatment. The treatment of asymptomatic bacteriuria is discouraged, but it still frequently occurs in the inpatient setting; it is less studied in the Emergency Department (ED). In this study, we examine associations between urine testing, inappropriate antibiotic use, and length of stay in discharged ED patients at risk of urinary tract infection (UTI) misdiagnosis.
METHODS
A cohort of discharged ED patients at risk of UTI misdiagnosis was created by pulling visit information for patients presenting with abdominal pain, chest pain, headache, vaginal bleeding in pregnancy, and elderly females with weakness or confusion. Predictors of urine testing, and urinary tract infection treatment were determined with logistic regression analysis. A chart review of a representative sample of this cohort was then completed screening for the presence of urinary tract symptoms and urine culture results. Linear regression analysis was then used to generate an adjusted mean difference in length of stay between patients who had urine testing compared to those who did not.
RESULTS
About a quarter of chest pain and headache patients had urine testing, while approximately 75% of abdominal pain patients, vaginal bleeding in pregnancy, and elderly females with weakness or confusion did. Except for chest pain patients, the UTI treatment rate was more than double the positive culture rate, indicating overtreatment. A diagnosis of UTI is based on a combination of UTI symptoms and positive urine cultures, yet only about 15% of patients treated for UTI met these criteria. Lastly, in all chief complaint groups, the length of stay was significantly longer-30 min or more-for those who had urine testing compared to matched controls.
CONCLUSIONS
In this observational study of patients at risk of UTI misdiagnosis, urine testing was associated with inappropriate antibiotic use and delayed discharge. There is pressure on providers to perform diagnostic testing, but in patients without specific UTI symptoms, urine testing might cause more harm than benefit.
背景
让患病可能性低的患者接受特征不佳的诊断检测会导致假阳性结果。医疗服务提供者常常依据这些错误结果采取行动，这可能会引发不必要的评估和治疗。不鼓励对无症状菌尿进行治疗，但在住院环境中这种情况仍频繁发生；在急诊科（ED）对此的研究较少。在本研究中，我们探讨了尿液检测、不恰当使用抗生素以及出院的有尿路感染（UTI）误诊风险的急诊科患者住院时间之间的关联。
方法
通过提取出现腹痛、胸痛、头痛、孕期阴道出血以及虚弱或意识模糊的老年女性患者的就诊信息，建立了一组有UTI误诊风险的出院急诊科患者队列。通过逻辑回归分析确定尿液检测和尿路感染治疗的预测因素。然后对该队列的一个代表性样本进行病历审查，筛查是否存在尿路症状和尿培养结果。接着使用线性回归分析得出进行尿液检测的患者与未进行尿液检测的患者之间住院时间的调整后平均差异。
结果
约四分之一的胸痛和头痛患者进行了尿液检测，而约75%的腹痛患者、孕期阴道出血患者以及虚弱或意识模糊的老年女性患者进行了尿液检测。除胸痛患者外，UTI治疗率是阳性培养率的两倍多，表明存在过度治疗。UTI的诊断基于UTI症状和阳性尿培养结果的综合判断，但接受UTI治疗的患者中只有约15%符合这些标准。最后，在所有主要症状组中，进行尿液检测的患者的住院时间比匹配的对照组显著延长30分钟或更多。
结论
在这项针对有UTI误诊风险患者的观察性研究中，尿液检测与不恰当使用抗生素和出院延迟有关。医疗服务提供者有进行诊断检测的压力，但对于没有特定UTI症状的患者，尿液检测可能弊大于利。
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