Predictive value of urine microscopy and urine culture in bacteraemic adults without localising urinary features.

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL Internal Medicine Journal Pub Date : 2024-10-22 DOI:10.1111/imj.16542

Nicholas Young, Jenna Beaumont, Alexandra Maling, Christopher Hopkins

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Abstract

Background: Urine microscopy (UM) and urine culture (UC) are used in bacteraemic patients to identify a urinary focus of infection. However, their positive and negative predictive values (PPV and NPV) in patients without localising urinary features are uncertain.

Aims: We aimed to determine the predictive value of UM/UC for diagnosing bacteraemic urinary tract infection (bUTI) in bacteraemic patients without localising urinary features.

Methods: A retrospective study of bacteraemic adults was conducted. PPV and NPV of UM/UC for bacteraemic urinary tract infection (bUTI) was determined in two subgroups of patients without localising urinary features: those with an unclear focus of infection, and those with a suspected non-urinary focus of infection. In those with an unclear focus, univariate analysis for risk factors associated with bUTI was performed.

Results: A total of 871 patients were included. Localising urinary features were absent in 110 of 342 patients (32.2%) with bUTI. In patients with an unclear focus, UM had a PPV of 51.5% and an NPV of 96% for bUTI, and UC had a PPV of 75% and an NPV of 88.6%. In patients with a suspected non-urinary focus, UM had a PPV of 5.2% and an NPV of 100%, and UC had a PPV of 25% and an NPV of 99.5%. While some risk factors for bUTI in patients with an unclear focus were identified, 22 of 98 patients (22.4%) had bUTI despite no risk factors.

Conclusions: bUTI without localising urinary features is common. In bacteraemia of unclear focus, UM/UC has a high NPV for excluding bUTI, although PPV is limited and non-urinary foci require consideration despite a positive result. UM/UC is low yield in those with a suspected non-urinary focus of infection.

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尿液显微镜检查和尿液培养对无局部泌尿系统特征的细菌感染成人的预测价值。

背景：尿液显微镜检查（UM）和尿液培养（UC）用于菌血症患者，以确定泌尿系统感染病灶。目的：我们旨在确定尿液显微镜检查/尿液培养在诊断无局部泌尿系统特征的菌血症患者尿路感染（bUTI）时的预测值：方法：对菌血症成人进行回顾性研究。方法：对成人菌血症患者进行了回顾性研究，在两组无局部泌尿系统特征的患者中确定了 UM/UC 对于菌血症性尿路感染（bUTI）的 PPV 和 NPV：感染病灶不明确的患者和疑似非泌尿系统感染病灶的患者。在病灶不明确的患者中，对与 bUTI 相关的风险因素进行了单变量分析：结果：共纳入 871 例患者。在 342 例尿路感染患者中，有 110 例（32.2%）不具备尿路定位特征。在病灶不明确的患者中，UM 对 bUTI 的 PPV 为 51.5%，NPV 为 96%，UC 的 PPV 为 75%，NPV 为 88.6%。在疑似非尿路病灶患者中，UM 的 PPV 为 5.2%，NPV 为 100%，UC 的 PPV 为 25%，NPV 为 99.5%。虽然在病灶不明确的患者中发现了一些引起细菌性尿路感染的危险因素，但在 98 例患者中有 22 例（22.4%）在没有危险因素的情况下也患上了细菌性尿路感染。在病灶不明确的菌血症中，UM/UC 在排除 bUTI 方面的 NPV 很高，但 PPV 有限，而且尽管结果呈阳性，仍需考虑非泌尿系统病灶。对于疑似非泌尿系统感染灶的患者，UM/UC 的阳性率较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.