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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 張尚仁 | 停經前婦女發生急性膀胱炎的尿液培養結果 | 2016/2/26 下午 06:20:56 | 0 |
| 原 文 | 題 目 | Voided midstream urine culture and acute cystitis in premenopausal women. |
| 作 者 | Hooton TM1, Roberts PL, Cox ME, Stapleton AE. | |
| 出 處 | N Engl J Med. 2013;369 (20):1883-91. | |
| 出版日期 | 2013 Nov 14 | |
| 評 論 | 急性膀胱炎是最常見的感染疾病之一。女性一輩子中發生急性膀胱炎的機會超過三分之二，雖然在健康的停經前女性，大部分急性膀胱炎症狀都很輕微，症狀包含了排尿疼痛，頻尿，急尿，血尿及下腹部疼痛，服用3-7天抗生素便可以治癒，也很少會進展成為嚴重的腎盂腎炎，然而當膀胱炎發作的時候造成女性相當的身體不適及生活品質的影響。女性下泌尿道感染的定義為有感染症狀的女性，且其尿液細菌培養為coliform ≧102 CFU/ml或noncoliform ≧105CFU/ml (CFU:colony-forming units).一般門診時，我們通常臨床症狀及尿液分析即可診斷。需要採取尿液培養時，比較標準的作法是經由膀胱穿刺或者經由導尿來取得尿液檢體，但臨床往往採用中段尿來做為尿液培養的檢體，在採集尿液的過程中，尤其是女性，容易有檢體汙染的情形發生。因此中段尿的尿液培養較為不可信。以前很少有研究探討中段尿和導尿的培養結果一致性的探討，此篇論文發現和過去的結果一致的是大腸桿菌占了大多數婦女泌尿道感染的結果，而且導尿和中段尿的培養相當一致可信。不過，格蘭性陽性菌例如腸球菌和鏈球菌的結果卻相當的不一致，如果在中段尿中培養出腸球菌和鏈球菌，在其對應的導尿培養中大部分找不到腸球菌和鏈球菌，反而是大腸桿菌比較常見，因此他們認為雖然中段尿液培養出的格蘭性陰性菌結果相當準確，不過陽性菌結果並不準確，由於大部分的導尿尿液培養都是格蘭性陰性菌，作者結論一般的停經前女性膀胱炎並不需要常規的作中段尿尿液培養。雖然此研究設計相當簡單且方法學並不困難卻登在新英格蘭醫學雜誌可見其結果對於臨床相當有意義。 | |
| abstract |
摘要 BACKGROUND: The cause of acute uncomplicated cystitis is determined on the basis of cultures of voided midstream urine, but few data guide the interpretation of such results, especially when gram-positive bacteria grow. METHODS: Women from 18 to 49 years of age with symptoms of cystitis provided specimens of midstream urine, after which we collected urine by means of a urethral catheter for culture (catheter urine). We compared microbial species and colony counts in the paired specimens. The primary outcome was a comparison of positive predictive values and negative predictive values of organisms grown in midstream urine, with the presence or absence of the organism in catheter urine used as the reference. RESULTS: The analysis of 236 episodes of cystitis in 226 women yielded 202 paired specimens of midstream urine and catheter urine that could be evaluated. Cultures were positive for uropathogens in 142 catheter specimens (70%), 4 of which had more than one uropathogen, and in 157 midstream specimens (78%). The presence of Escherichia coli in midstream urine was highly predictive of bladder bacteriuria even at very low counts, with a positive predictive value of 10(2) colony-forming units (CFU) per milliliter of 93% (Spearmans r=0.944). In contrast, in midstream urine, enterococci (in 10% of cultures) and group B streptococci (in 12% of cultures) were not predictive of bladder bacteriuria at any colony count (Spearmans r=0.322 for enterococci and 0.272 for group B streptococci). Among 41 episodes in which enterococcus, group B streptococci, or both were found in midstream urine, E. coli grew from catheter urine cultures in 61%. CONCLUSIONS: Cultures of voided midstream urine in healthy premenopausal women with acute uncomplicated cystitis accurately showed evidence of bladder E. coli but not of enterococci or group B streptococci, which are often isolated with E. coli but appear to rarely cause cystitis by themselves. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.). |
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