François P, Croiźe J, Weil G, Bost C
Fédération d'évaluation hospitalière, CHU de Grenoble.
Rev Epidemiol Sante Publique. 1994;42(6):520-8.
The objective of this study was to describe the conditions in which urinary tract infections in children are managed by ambulatory medical services and compare the results with recommendations of experts in the field. For a period of one month, we focused on the methods of urine sample collection by observing 149 urinalyses for children under 15 in 13 private medical laboratories. Secondly, we investigated cases involving 26 prescribing physicians in order to assess treatment and additional testing on 28 children whose urine cultures showed significant bacterial growth. Urine samples were collected at home by parents in 72% of the cases, often with defective procedures: improper antisepsis for pre-collection cleansing in 65% of the cases, in 51% of the cases the maximum time lapse between the moment a collection-bag was applied and the moment the filled bag was removed was overrun. Compared with standard techniques, the quality of the samples was deemed questionable in 33% of cases and unacceptable in 41%. Attending physicians diagnosed urinary infections in 22 children. The antibiotic treatment prescribed to these children was apparently insufficient in 40% of the cases. Less than a third of the infected children benefited from a radiologic examination of the urinary tract. This study demonstrates that adherence to rules inherent in managing pediatric urinary infections is less than satisfactory in ambulatory medicine. It appears necessary to improve the quality of urinalysis by inciting laboratories to collect urine samples in laboratory. Physicians should also be better informed of the results of consensus conferences.
本研究的目的是描述门诊医疗服务管理儿童尿路感染的情况，并将结果与该领域专家的建议进行比较。在为期一个月的时间里，我们通过观察13家私立医学实验室对15岁以下儿童进行的149次尿液分析，重点关注尿液样本的采集方法。其次，我们调查了26名开处方医生的病例，以评估对28名尿液培养显示有显著细菌生长的儿童的治疗和进一步检测情况。72%的病例中，尿液样本由家长在家中采集，采集程序往往存在缺陷：65%的病例中，采集前清洁的消毒不当；51%的病例中，从使用集尿袋到取出装满尿液的集尿袋的最长时间超过规定。与标准技术相比，33%的病例样本质量被认为有问题，41%的病例样本质量不可接受。主治医生诊断出22名儿童患有尿路感染。这些儿童接受的抗生素治疗在40%的病例中明显不足。不到三分之一的受感染儿童接受了泌尿系统的放射学检查。这项研究表明，在门诊医疗中，遵守儿童尿路感染管理的固有规则情况不尽人意。似乎有必要通过促使实验室在实验室采集尿液样本，来提高尿液分析的质量。医生也应该更好地了解共识会议的结果。
