High Diagnostic Accuracy of Nitrite Test Paired with Urine Sediment can Reduce Unnecessary Antibiotic Therapy.

Q3 Immunology and Microbiology

Open Microbiology Journal Pub Date : 2015-11-03 eCollection Date: 2015-01-01 DOI:10.2174/1874285801509010150

Sven A Ferry, Stig E Holm, B Magnus Ferry, Tor J Monsen

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Abstract

Background: Urinary tract infections (UTIs) are common bacterial infections dominated by lower UTI in women (LUTIW). Symptoms only are insufficient for diagnosis and accordingly, near patient diagnostic tests confidently confirming significant bacteriuria are desirable. The nitrite test (NIT) has low sensitivity, while bacterial and leukocyte counts disjunctively paired in urine sediment microscopy (SED) have high sensitivity. Similar symptomatic cure rates are found post antibiotic vs. placebo therapy in patients with negative cultures. Consequently, prescription on symptoms only implies unnecessary antibiotic therapy.

Aims: to evaluate the diagnostic outcomes of NIT, SED and NIT disjunctively paired with SED (NIT+SED) vs. urine culture, with special focus on bladder incubation time (BIT), and to assess if NIT+SED can reduce unnecessary antibiotic therapy.

Methods: A diagnostic, primary care, multicentre study including 1070 women with symptoms suggestive of lower UTI.

Results: Significant bacteriuria was found in 77%. The BIT highly influenced the diagnostic outcomes and the optimal duration was ≥4h with sensitivity of 66, 90 and 95% for NIT, SED and NIT+SED, respectively. SED performed only in NIT negative specimens could reduce unnecessary antibiotics by 10% vs. prescription on symptoms only. The number needed to test with SED to reduce one unnecessary antibiotic course was five patients at BIT ≥4h and six patients at ≤3h or overall.

Conclusion: The BIT highly influences the diagnostic outcomes with the highest accuracy of NIT+SED. Diagnosis of LUTIW with NIT+SED can reduce unnecessary antibiotic therapy and subsequently decrease antimicrobial resistance.

Trial registration: The Swedish Medical Product Agency 1995 03 01:151:01783/94.

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亚硝酸盐检测结合尿沉渣诊断准确率高，可减少不必要的抗生素治疗。

背景：尿路感染（UTIs）是一种常见的细菌感染，以女性尿路感染较低（LUTIW）为主。仅症状不足以进行诊断，因此，需要通过近患者诊断测试来自信地确认显著的菌尿。亚硝酸盐试验（NIT）的灵敏度较低，而尿液沉积物显微镜（SED）中细菌和白细胞计数分离配对的灵敏度较高。在阴性培养的患者中，抗生素治疗后与安慰剂治疗后的症状治愈率相似。因此，对症状开出处方只意味着不必要的抗生素治疗。目的：评估NIT、SED和NIT与SED分离配对（NIT+SED）与尿液培养的诊断结果，特别关注膀胱培养时间（BIT），并评估NIT+SED是否可以减少不必要的抗生素治疗。方法：一项诊断性、初级保健、多中心研究，包括1070名症状提示尿路感染较低的女性。结果：77%的患者出现明显的菌尿。BIT对诊断结果有很大影响，最佳持续时间≥4h，NIT、SED和NIT+SED的敏感性分别为66%、90%和95%。仅在NIT阴性标本中进行SED可以将不必要的抗生素减少10%，而仅针对症状开具处方。为了减少一个不必要的抗生素疗程，在BIT≥4h时需要使用SED进行测试的人数为5名患者，在≤3h或总体时需要6名患者。结论：BIT对诊断结果有很大影响，NIT+SED的准确率最高。NIT+SED诊断LUTIW可以减少不必要的抗生素治疗，从而降低耐药性。试验注册：瑞典医疗产品代理1995 03 01:151:01783/94。

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来源期刊

Open Microbiology Journal Immunology and Microbiology-Immunology and Microbiology (all)

CiteScore

1.80

自引率

0.00%

发文量

期刊介绍： The Open Microbiology Journal is a peer-reviewed open access journal which publishes research articles, reviews/mini-reviews, case studies, guest edited thematic issues and short communications/letters covering theoretical and practical aspects of Microbial systematics, evolutionary microbiology, immunology, virology, parasitology , bacteriology, mycology, phycology, protozoology, microbial ecology, molecular biology, microbial physiology, biochemistry, microbial pathogenesis, host-microbe interaction, systems microbiology, synthetic microbiology, bioinformatics. The Open Microbiology Journal , a peer-reviewed journal, is an important and reliable source of current information on developments in the field. The emphasis will be on publishing quality papers rapidly and freely available to researchers worldwide.