Abstract：
OBJECTIVE: To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals.
METHODS: Prospective population-based cohort study.
METHODS: North Denmark.
METHODS: All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021.
METHODS: UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite.
RESULTS: Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. Modified Poisson regression yielded an adjusted relative risk of 4.41 (95% CI 2.40 to 8.11) for empirical antibiotics for UTI in participants without specific UTI symptoms and a positive dipstick.
CONCLUSIONS: Dipsticks yielded limited clinical decision support compared with a symptom-driven approach in this study and were independently associated with excess antibiotics for UTI.
METHODS: Prospective population-based cohort study.
METHODS: North Denmark.
METHODS: All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021.
METHODS: UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite.
RESULTS: Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. Modified Poisson regression yielded an adjusted relative risk of 4.41 (95% CI 2.40 to 8.11) for empirical antibiotics for UTI in participants without specific UTI symptoms and a positive dipstick.
CONCLUSIONS: Dipsticks yielded limited clinical decision support compared with a symptom-driven approach in this study and were independently associated with excess antibiotics for UTI.
摘要：
目的：确定试纸对急性住院患者尿路感染（UTI）的附加诊断价值。
方法：前瞻性基于人群的队列研究。
方法：北丹麦。
方法：从2021年9月20日至10月23日，所有成年人（≥18岁）在北丹麦地区的急诊科接受试纸检查。
方法：UTI定义为新发频率≥1种症状，排尿困难或耻骨上压痛伴尿液培养阳性。阳性试纸被定义为白细胞酯酶和/或亚硝酸盐的任何反应。
结果：1052/2495（42%）的急性住院患者使用试纸，中位年龄为73岁（IQR57-82），女性为540（51%）。总的来说,89/1052（8％）符合UTI标准，607/1052（58％）患者进行了尿液培养。在接受试纸和尿培养的患者中，UTI的敏感性和特异性分别为87%(95%CI78%~93%)和45%(95%CI41%~50%).阳性和阴性预测值分别为21%（95%CI17%至26%）和95%（95%CI92%至98%），而阳性和阴性似然比分别为1.58(95%CI1.41~1.77)和0.30(95%CI0.18~0.51).在具有特定UTI症状的参与者中，UTI的最前概率为29％至60％，如果试纸为阳性，则相应的测试后概率为35-69％，如果试纸为阴性，则为12-27％。如果将最终临床诊断用作所有使用试纸检查的患者的结果，则结果仍具有可比性。在没有特定UTI症状和阳性试纸的参与者中，改良泊松回归对UTI经验性抗生素的校正相对风险为4.41（95％CI2.40至8.11）。
结论：在这项研究中，与症状驱动的方法相比，Dipstics产生的临床决策支持有限，并且与UTI的过量抗生素独立相关。
方法：前瞻性基于人群的队列研究。
方法：北丹麦。
方法：从2021年9月20日至10月23日，所有成年人（≥18岁）在北丹麦地区的急诊科接受试纸检查。
方法：UTI定义为新发频率≥1种症状，排尿困难或耻骨上压痛伴尿液培养阳性。阳性试纸被定义为白细胞酯酶和/或亚硝酸盐的任何反应。
结果：1052/2495（42%）的急性住院患者使用试纸，中位年龄为73岁（IQR57-82），女性为540（51%）。总的来说,89/1052（8％）符合UTI标准，607/1052（58％）患者进行了尿液培养。在接受试纸和尿培养的患者中，UTI的敏感性和特异性分别为87%(95%CI78%~93%)和45%(95%CI41%~50%).阳性和阴性预测值分别为21%（95%CI17%至26%）和95%（95%CI92%至98%），而阳性和阴性似然比分别为1.58(95%CI1.41~1.77)和0.30(95%CI0.18~0.51).在具有特定UTI症状的参与者中，UTI的最前概率为29％至60％，如果试纸为阳性，则相应的测试后概率为35-69％，如果试纸为阴性，则为12-27％。如果将最终临床诊断用作所有使用试纸检查的患者的结果，则结果仍具有可比性。在没有特定UTI症状和阳性试纸的参与者中，改良泊松回归对UTI经验性抗生素的校正相对风险为4.41（95％CI2.40至8.11）。
结论：在这项研究中，与症状驱动的方法相比，Dipstics产生的临床决策支持有限，并且与UTI的过量抗生素独立相关。
