Hoberman A, Wald E R, Reynolds E A, Penchansky L, Charron M
Department of Pediatrics, University of Pittsburgh School of Medicine, PA, USA.
Pediatr Infect Dis J. 1996 Apr;15(4):304-9. doi: 10.1097/00006454-199604000-00005.
To determine whether the absence of pyuria on the enhanced urinalysis can be used to eliminate the diagnosis of urinary tract infection, avoiding the need for urine culture and sparing large health care expenditures.
Results of an enhanced urinalysis (hemocytometer counts and interpretation of Gram-stained smears) performed on uncentrifuged urine specimens obtained by catheter were correlated with urine cultures in young febrile children at the Children's Hospital of Pittsburgh Emergency Department. In a group of 4253 children (95% febrile) less than 2 years of age, pyuria was defined as > or = 10 white blood cells/mm3, bacteriuria as any bacteria on any of 10 oil immersion fields in a Gram-stained smear and a positive culture as > or = 50,000 colony-forming units/ml. A subgroup of 153 children with their first diagnosed urinary tract infection were enrolled in a separate treatment trial, acute phase reactants (peripheral white blood cell count, erythrocyte sedimentation rate and C-reactive protein) were obtained and 99Tc-dimercaptosuccinic acid renal scans were performed.
The presence of either pyuria or bacteriuria and the presence of both pyuria and bacteriuria have the highest sensitivity (95%) and positive predictive value (85%), respectively, for identifying positive urine cultures. Because a white blood cell count in a hemocytometer is the technically simpler component of the enhanced urinalysis, we chose to analyze the false negative results and achievable cost savings of using pyuria alone as the sole criterion for omitting urine cultures. If in this study urine cultures had been performed only on specimens from children who had pyuria or were managed presumptively with antibiotics, cultures of 2600 (61%) specimens would have been avoided. Twenty-two of 212 patients with positive urine cultures would not have been identified initially. However, based on interpretation of acute phase reactants, initial 99Tc-dimercaptosuccinic acid scan results, response to management and incidence of renal scarring 6 months later, 14 of the 22 patients most likely had asymptomatic bacteriuria and fever from another cause. The remaining 8 patients probably had early urinary tract infection.
The analysis of urine samples obtained by catheter for the presence of significant pyuria (> or = 10 white blood cells/mm3) can be used to guide decisions regarding the need for urine culture in young febrile children.
确定强化尿液分析中无脓尿是否可用于排除尿路感染的诊断，从而避免进行尿培养并节省大量医疗费用。
对匹兹堡儿童医院急诊科发热幼儿通过导尿管获取的未离心尿液标本进行强化尿液分析（血细胞计数和革兰氏染色涂片解读）的结果与尿培养结果相关联。在一组4253名2岁以下儿童（95%发热）中，脓尿定义为白细胞≥10个/mm³，菌尿定义为革兰氏染色涂片中10个油镜视野中的任何细菌，阳性培养定义为菌落形成单位≥50,000/ml。153名首次诊断为尿路感染的儿童亚组被纳入一项单独的治疗试验，检测急性期反应物（外周白细胞计数、红细胞沉降率和C反应蛋白）并进行99锝-二巯基丁二酸肾扫描。
脓尿或菌尿的存在以及脓尿和菌尿同时存在分别对识别阳性尿培养具有最高的敏感性（95%）和阳性预测值（85%）。由于血细胞计数是强化尿液分析中技术上更简单的组成部分，我们选择分析仅将脓尿作为省略尿培养的唯一标准时的假阴性结果和可实现的成本节省。如果在本研究中仅对有脓尿或接受抗生素经验性治疗的儿童标本进行尿培养，2600份（61%）标本的培养可被避免。212名尿培养阳性患者中有22名最初不会被识别。然而，根据急性期反应物的解读、最初的99锝-二巯基丁二酸扫描结果、治疗反应以及6个月后肾瘢痕形成的发生率，22名患者中有14名很可能有无症状菌尿且发热由其他原因引起。其余8名患者可能患有早期尿路感染。
对通过导尿管获取的尿液样本进行显著脓尿（≥10个白细胞/mm³）分析可用于指导发热幼儿是否需要进行尿培养的决策。
