目的:尿路感染(UTI)在老年妇女中很常见。然而,由于常见的慢性下尿路症状(LUTS),诊断具有挑战性,认知障碍,无症状菌尿(ASB)的患病率很高。目前的尿液诊断缺乏特异性,导致不必要的治疗和抗菌素耐药性。这项研究旨在评估十二种尿液生物标志物在诊断老年女性UTI中的诊断准确性。
方法:在本病例对照研究中,病例为≥65岁的女性,≥2例新发LUTS,脓尿和一种尿路病原体≥104CFU/mL。对照无症状,分类为ASB(一种尿路病原体≥105CFU/mL),负培养或混合菌群。通过液相色谱-质谱和ELISA测量尿液生物标志物浓度。个体生物标志物和生物标志物模型的诊断准确性参数来源于ROC曲线。
结果:我们纳入了162名社区居住和住院的老年妇女。五种尿液炎症生物标志物显示出高辨别能力(AUC≥0.80):白细胞介素6(IL-6),天青苦素,中性粒细胞明胶酶相关脂质运载蛋白(NGAL),金属蛋白酶组织抑制剂2(TIMP-2),和C-X-C基序趋化因子9(CXCL-9)。Azurocidin在16.7ng/mmol肌酐时表现出最高的诊断准确性(敏感性86%(95%置信区间(CI)75-93%)和特异性89%(95%CI82-94%)。联合生物标志物和脓尿模型显示UTI和ASB患者的诊断准确性提高,与单独的脓尿相比。
结论:我们确定了几种尿液生物标志物,可以准确区分患有UTI的老年女性和无症状女性,包括ASB。这些发现代表了在老年妇女中改善UTI诊断的潜在进步,并保证在不同人群中得到验证。国际临床试验注册平台:试验IDNL9477(https://trialsearch.谁。int/Trial2。aspx?TrialID=NL9477)。
OBJECTIVE: Urinary tract infection (UTI) is common among older women. However, diagnosis is challenging because of frequent chronic lower urinary tract symptoms, cognitive impairment, and a high prevalence of asymptomatic bacteriuria (ASB). Current urine diagnostics lack specificity, leading to unnecessary treatment and antimicrobial resistance. This study aimed to evaluate the diagnostic accuracy of 12 urine biomarkers for diagnosing UTI in older women.
METHODS: In this
case-control study, cases were women ≥65 years with ≥2 new-onset lower urinary tract symptoms, pyuria, and one uropathogen ≥104 CFU/mL. Controls were asymptomatic and classified as ASB (one uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Urine biomarker concentrations were measured through liquid chromatography-mass spectrometry and ELISA. Diagnostic accuracy parameters of individual biomarkers and a biomarker model were derived from receiver operating characteristic curves.
RESULTS: We included 162 community-dwelling and institutionalized older women. Five urine inflammatory biomarkers demonstrated high discriminative ability (area under the curve ≥0.80): interleukin 6, azurocidin, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinases 2, and C-X-C motif chemokine 9. Azurocidin exhibited the highest diagnostic accuracy (sensitivity 86% [95% CI 75%-93%] and specificity 89% [95% CI 82%-94%] at 16.7 ng/mmol creatinine). A combined biomarker and pyuria model showed improved diagnostic accuracy in patients with UTI and ASB, compared with pyuria alone.
CONCLUSIONS: We identified several urine biomarkers that accurately differentiated older women with UTI from asymptomatic women, including ASB. These findings represent a potential advancement towards improved diagnostics for UTI in older women and warrant validation in a diverse population.