Hertz Mathias Amdi, Skjøt-Arkil Helene, Heltborg Anne, Lorentzen Morten Hjarnø, Cartuliares Mariana Bichuette, Rosenvinge Flemming S, Nielsen Stig Lønberg, Mogensen Christian Backer, Johansen Isik Somuncu
Department of Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark.
Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Denmark.
Heliyon. 2024 Jun 11;10(12):e32815. doi: 10.1016/j.heliyon.2024.e32815. eCollection 2024 Jun 30.
Urinary tract infections (UTIs) remain a leading infectious disease cause of admission to the emergency department (ED) and antibiotic prescription. Heterogeneity of disease presentation challenges early diagnostics, leading to improper antibiotic prescription and delayed diagnosis. Prior studies have relied on positive urine cultures for diagnosis, but its performance suffers from false positives and false negatives. This study aimed to identify factors associated with UTIs and describe patient characteristics and outcomes while not using positive urine culture as an obligatory part of diagnosis.
Adult patients admitted to the ED suspected of infection were prospectively included in an exploratory cross-sectional cohort study. An expert panel retrospectively determined the final diagnosis. Factors associated with a UTI were identified using univariate and multivariate logistic regression analysis, outcomes were evaluated with adjusted Cox regression analysis, and length of stay was compared with a zero-inflated negative binomial logistic regression model.
Of 966 patients who were enrolled, 200 were diagnosed with a UTI by the expert panel. We found a significant association between a UTI diagnosis and the typical UTI symptoms: dysuria (OR 7.8), change of urine appearance (OR 3.9), suprapubic or flank pain (OR 3.7), and increased urinary frequency (OR 3.2). Urinary dipstick analysis for white blood cells (WBCs) (OR 6.0-24.0), nitrite (OR 4.7), and blood (OR 3.6-12.0) was also significantly associated. Subgroup analysis of urinary dipstick analysis of men and women still showed significance in both groups. No significant difference in outcome or length of stay was found.
Typical UTI symptoms are associated with a UTI diagnosis, which underlines the importance of exploring a patient's medical history. Urinary dipstick analysis for WBC, nitrite, and blood is also strongly associated and should be considered when evaluating patients admitted to the ED with suspicion of infection.
尿路感染（UTIs）仍然是急诊室（ED）收治患者及抗生素处方开具的主要感染性疾病原因。疾病表现的异质性对早期诊断构成挑战，导致抗生素处方不当和诊断延迟。既往研究依赖尿培养阳性进行诊断，但其结果存在假阳性和假阴性问题。本研究旨在确定与UTIs相关的因素，并描述患者特征及结局，同时不将尿培养阳性作为诊断的必要组成部分。
前瞻性纳入因疑似感染入住ED的成年患者，进行探索性横断面队列研究。由专家小组回顾性确定最终诊断。采用单因素和多因素逻辑回归分析确定与UTI相关的因素，用校正后的Cox回归分析评估结局，并用零膨胀负二项逻辑回归模型比较住院时间。
在纳入的966例患者中，专家小组诊断出200例UTIs。我们发现UTI诊断与典型的UTI症状之间存在显著关联：尿痛（比值比[OR]7.8）、尿液外观改变（OR 3.9）、耻骨上或侧腹疼痛（OR 3.7）以及尿频增加（OR 3.2）。尿白细胞（WBC）（OR 6.0 - 24.0）、亚硝酸盐（OR 4.7）和血液（OR 3.6 - 12.0）的尿试纸分析也显著相关。对男性和女性进行尿试纸分析的亚组分析在两组中仍显示出显著性。在结局或住院时间方面未发现显著差异。
典型的UTI症状与UTI诊断相关，这突出了探究患者病史的重要性。对WBC、亚硝酸盐和血液的尿试纸分析也密切相关，在评估因疑似感染入住ED的患者时应予以考虑。
