Froom Paul, Shimoni Zvi
Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya 4244916, Israel.
School of Public Health, University of Tel Aviv, Tel Aviv 6997801, Israel.
Diagnostics (Basel). 2024 May 22;14(11):1078. doi: 10.3390/diagnostics14111078.
Patients treated for systemic urinary tract infections commonly have nonspecific presentations, and the specificity of the results of the urinalysis and urine cultures is low. In the following narrative review, we will describe the widespread misuse of urine testing, and consider how to limit testing, the disutility of urine cultures, and the use of antibiotics in hospitalized adult patients. Automated dipstick testing is more precise and sensitive than the microscopic urinalysis which will result in false negative test results if ordered to confirm a positive dipstick test result. There is evidence that canceling urine cultures if the dipstick is negative (negative leukocyte esterase, and nitrite) is safe and helps prevent the overuse of urine cultures. Because of the side effects of introducing a urine catheter, for patients who cannot provide a urine sample, empiric antibiotic treatment should be considered as an alternative to culturing the urine if a trial of withholding antibiotic therapy is not an option. Treatment options that will decrease both narrower and wider spectrum antibiotic use include a period of watching and waiting before antibiotic therapy and empiric treatment with antibiotics that have resistance rates > 10%. Further studies are warranted to show the option that maximizes patient comfort and safety.
接受全身性尿路感染治疗的患者通常表现不具特异性，尿液分析和尿培养结果的特异性较低。在以下叙述性综述中，我们将描述尿液检测的广泛滥用情况，并探讨如何限制检测、尿培养的无用性以及住院成年患者抗生素的使用。自动试纸检测比显微镜下尿液分析更精确、更灵敏，如果为了确认试纸检测结果为阳性而进行显微镜下尿液分析，可能会导致假阴性检测结果。有证据表明，如果试纸检测为阴性（白细胞酯酶和亚硝酸盐均为阴性），取消尿培养是安全的，有助于防止尿培养的过度使用。由于插入导尿管有副作用，对于无法提供尿液样本的患者，如果不选择暂停抗生素治疗的试验，应考虑经验性抗生素治疗作为尿培养的替代方法。减少窄谱和广谱抗生素使用的治疗选择包括在抗生素治疗前进行一段时间的观察等待，以及使用耐药率>10%的抗生素进行经验性治疗。有必要进行进一步研究以找出能使患者舒适度和安全性最大化的方案。
