在小儿尿路感染中调查尿路特征和最佳尿白细胞值:一项前性观察性研究
Jean Nee Teo1,2, Yong Teck Teo3, Sashikumar Ganapathy1,2
1Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
Annals of the Academy of Medicine, Singapore
|October 7, 2024
概括
在尿液分析中高的白细胞 (WBC) 数值值可能会错过儿科尿路感染 (UTI). 在尿液显微镜中降低WBC值可以减少儿童遗漏的尿路感染病例,平衡诊断准确性与资源使用.
科学领域:
- 儿科急救医学 儿科急救医学
- 临床诊断 临床诊断 临床诊断
- 微生物学 微生物学
背景情况:
- 尿路感染 (UTI) 在儿童中很常见.
- 确定的尿路感染诊断依赖于尿液培养,但用白细胞 (WBC) 计数进行尿液分析可以表明可能性.
- 在尿液分析中优化WBC值对于在紧急情况下准确和有效的儿科尿路感染诊断至关重要.
研究的目的:
- 在尿液分析中确定最佳的尿液白血细胞计数值,用于预测小儿科患者的尿路感染,并向急诊室 (ED) 提交.
- 评估不同WBC值的诊断性能,以预测培养证明的尿路感染.
主要方法:
- 在儿科急诊室进行的前性观察研究.
- 包括18岁以下的儿童接受尿液显微镜和尿液培养.
- 用灵敏度,特异性,预测值,概率比率和ROC曲线分析评估各种尿液WBC值.
主要成果:
- 总体来看,通过培养证明的尿路感染率为38.7%.
- 在尿液分析中,WBC值≥100/μL显示了82.2%的灵敏度和86.2%的负预测值.
- 降低WBC值至≥10/μL显著减少了缺失的尿路感染,从酸盐阴性样本的17.3%降至2.2%,每年尿液培养量可能增加419%.
结论:
- 尿液显微镜WBC值≥100/μL导致了临床上显著的儿童遗漏尿路感染率.
- 调整WBC值需要仔细考虑遗漏尿路感染率和实验室资源利用率之间的权衡.
- 降低WBC值可能会改善儿童的尿路感染检测,特别是在亚酸盐阴性病例中.
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