Brubaker Linda, Chai Toby C, Horsley Harry, Khasriya Rajvinder, Moreland Robert B, Wolfe Alan J
Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, La Jolla, CA, United States.
Department of Urology, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States.
Front Urol. 2023 Jul 11;3:1206046. doi: 10.3389/fruro.2023.1206046. eCollection 2023.
Diagnosis and treatment of urinary tract infections (UTIs) remains stagnant. The presumption that a patient either has a UTI or does not (binary choice) is inappropriately simplistic. Laboratory diagnostic tests have not advanced for decades. The goal of UTI treatment has not been rigorously defined and may increase the prescription of potentially harmful, inappropriate antibiotics. Despite the high incidence of UTI diagnoses, the high cost of UTI treatment, and increasing concerns associated with antimicrobial resistance, the development of novel and more accurate UTI tests has not been considered a priority, in part due to the general perception that current UTI care is already sufficient. In this review, we discuss the importance of improving UTI diagnostic testing to improve treatment outcomes. We discuss the problems associated with UTI diagnosis. Urinary microbes are alive and exist in both healthy and symptomatic individuals-urine is not sterile. We specifically outline the limitations of standard urine culture methods used by clinical microbiology laboratories, explaining clearly why such methods cannot be considered to be the "gold standard," as standard culture methods underreport most of the urinary tract microbes, including some acknowledged and many emerging uropathogens. We do not recommend abandonment of this test, as no universally accepted substitute yet exists. However, we strongly encourage the development of new and improved diagnostic tests that can both improve outcomes and preserve antibiotic stewardship.
尿路感染（UTIs）的诊断和治疗仍停滞不前。认为患者要么患有尿路感染，要么没有（二元选择）这种假设过于简单化且并不恰当。实验室诊断测试几十年来都没有进展。尿路感染治疗的目标尚未得到严格界定，这可能会增加潜在有害、不恰当抗生素的处方量。尽管尿路感染诊断的发生率很高，治疗成本高昂，且对抗菌素耐药性的担忧与日俱增，但新型且更准确的尿路感染检测方法的研发却未被视为优先事项，部分原因是普遍认为当前的尿路感染护理已经足够。在本综述中，我们讨论了改进尿路感染诊断检测以改善治疗结果的重要性。我们探讨了与尿路感染诊断相关的问题。尿路微生物是有生命的，存在于健康个体和有症状个体中——尿液并非无菌。我们特别概述了临床微生物实验室使用的标准尿液培养方法的局限性，清楚地解释了为什么不能将此类方法视为“金标准”，因为标准培养方法会漏报大多数尿路微生物，包括一些已被认可的以及许多新出现的尿路病原体。我们不建议放弃这项检测，因为目前还没有普遍接受的替代方法。然而，我们强烈鼓励开发新的、改进的诊断测试，既能改善治疗结果，又能维护抗生素管理。
