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首页> 外文期刊>BMC Family Practice >Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs
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Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs

机译：预测女性急性单纯性尿路感染：症状和体征的诊断准确性的系统评价

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Background Acute urinary tract infections (UTI) are one of the most common bacterial infections among women presenting to primary care. However, there is a lack of consensus regarding the optimal reference standard threshold for diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and signs in women presenting with suspected UTI, across three different reference standards (102 or 103 or 105 CFU/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results in terms of clinical decision making. Methods Searches were performed through PubMed (1966 to April 2010), EMBASE (1973 to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking. Studies that assessed the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a clean-catch or catherised urine specimen as the reference standard, with a reference standard of at least ≥ 102 CFU/ml were included. Synthesised data from a high quality systematic review were used regarding dipstick results. Studies were combined using a bivariate random effects model. Results Sixteen studies incorporating 3,711 patients are included. The weighted prior probability of UTI varies across diagnostic threshold, 65.1% at ≥ 102 CFU/ml; 55.4% at ≥ 103 CFU/ml and 44.8% at ≥ 102 CFU/ml ≥ 105 CFU/ml. Six symptoms are identified as useful diagnostic symptoms when a threshold of ≥ 102 CFU/ml is the reference standard. Presence of dysuria (+LR 1.30 95% CI 1.20-1.41), frequency (+LR 1.10 95% CI 1.04-1.16), hematuria (+LR 1.72 95%CI 1.30-2.27), nocturia (+LR 1.30 95% CI 1.08-1.56) and urgency (+LR 1.22 95% CI 1.11-1.34) all increase the probability of UTI. The presence of vaginal discharge (+LR 0.65 95% CI 0.51-0.83) decreases the probability of UTI. Presence of hematuria has the highest diagnostic utility, raising the post-test probability of UTI to 75.8% at ≥ 102 CFU/ml and 67.4% at ≥ 103 CFU/ml. Probability of UTI increases to 93.3% and 90.1% at ≥ 102 CFU/ml and ≥ 103 CFU/ml respectively when presence of hematuria is combined with a positive dipstick result for nitrites. Subgroup analysis shows improved diagnostic accuracy using lower reference standards ≥ 102 CFU/ml and ≥ 103 CFU/ml. Conclusions Individual symptoms and signs have a modest ability to raise the pretest-risk of UTI. Diagnostic accuracy improves considerably when combined with dipstick tests particularly tests for nitrites.
机译：背景技术急性尿路感染（UTI）是就诊初级保健的女性中最常见的细菌感染之一。然而，关于用于诊断UTI的最佳参考标准阈值缺乏共识。本系统综述的目的是确定三种不同参考标准（10 2 或10 3 或10 5 CFU / ml）。我们还将根据临床决策来检查个别症状和体征以及量油尺测试结果的诊断价值。方法通过PubMed（1966年至2010年4月），EMBASE（1973年至2010年4月），Cochrane库（1973年至2010年4月），谷歌学者和参考文献进行搜索。评估以干净捕捞或经凯瑟琳化的尿液样本中的尿培养物为参考标准，且参考标准至少≥10 2 CFU的简单尿路感染的症状和体征的诊断准确性的研究/ ml包括在内。使用了高质量的系统评价得出的关于量油尺结果的综合数据。使用双变量随机效应模型合并研究。结果纳入16项研究，纳入3,711例患者。尿路感染的加权先验概率因诊断阈值而异，在≥10 2 CFU / ml时为65.1％; ≥10 3 CFU / ml时为55.4％，≥10 2 CFU / ml≥10 5 CFU / ml时为44.8％。当阈值≥10 2 CFU / ml作为参考标准时，有六个症状被确定为有用的诊断症状。排尿困难（+ LR 1.30 95％CI 1.20-1.41），频率（+ LR 1.10 95％CI 1.04-1.16），血尿（+ LR 1.72 95％CI 1.30-2.27），夜尿症（+ LR 1.30 95％CI 1.08） -1.56）和紧急程度（+ LR 1.22 95％CI 1.11-1.34）都增加了UTI的可能性。白带的存在（+ LR 0.65 95％CI 0.51-0.83）降低了尿路感染的可能性。血尿的存在具有最高的诊断效用，在≥10 2 CFU / ml时，UTI的检后概率提高到75.8％，在≥10 3 CFU / ml时，UTI的检后概率提高到67.4％。毫升当血尿的存在与试纸阳性结果结合使用时，≥10 2 CFU / ml和≥10 3 CFU / ml时，尿路感染的概率分别增加至93.3％和90.1％用于亚硝酸盐。亚组分析显示使用较低的参考标准品≥10 2 CFU / ml和≥10 3 CFU / ml可以提高诊断准确性。结论个别症状和体征具有适度的能力提高尿路感染的前测风险。当与量油尺测试（尤其是亚硝酸盐测试）结合使用时，诊断准确性会大大提高。

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