73例尿培养菌落计数不达标标本的临床分析

Substandard Quantitative Urine Culture:An Analysis of 73 Cases

目的分析尿培养菌落计数不达标的原因,以提高尿细菌学检测的临床符合率。方法对73例尿培养菌落计数不达标住院患者的临床资料进行回顾性分析。结果 73例尿培养菌落计数不达标患者中82.19%(60/73)有真性尿路感染。81.67%(49/60)的患者提前使用了抗生素,但抗生素提前使用的有效率仅为48.98%(24/49)。有临床尿路感染者尿沉渣涂片镜检有WBC所占比例显著高于尿沉渣涂片镜检无WBC的病例、尿培养阴性所占比例显著高于尿培养阳性(均P<0.01)。尿培养+尿沉渣涂片镜检阳性、阴性总符合率和误诊率均显著高于尿培养(均P<0.01)。结论单纯尿定量培养不足以对提前使用抗生素患者进行尿路感染的实验室诊断,需要结合尿沉渣涂片以排除因抗生素误用或滥用导致的假阴性报告。

Objective To analyze the causes of substandard quantitative urine culture,and to improve the compliance rate of urinary bacteriological detection.Methods Clinical data of 73 pa-tients with substandard urine culture bacterial colony counts were analyzed retrospectively.Re-sults Among the 73 patients,60（82.19%）had true urinary tract infection.Among the 60 pa-tients,antibiotics were used in 49（81.67%）.However,the effective rate of early use of antibiotics was only 48.98%（24/49）.The microscopic examination of urine sediment showed that the per-centage of patients with the presence of white blood cells was significantly higher than that of pa-tients without the presence of white blood cells（P 〈0.01）.In addition,the percentage of urine culture-negative patients was significantly higher than that of urine culture-positive patients（P 〈0.01）.The overall compliance rate and misdiagnosis rate of the combination of urine culture and urine sediment microscopy were significantly higher than those of urine culture alone（P 〈0.01）. Conclusion The quantitative urine culture alone is insufficient for the laboratory diagnosis of uri-nary tract infection in patients who receive antibiotics in advance.It must be combined with urine sediment microscopy to exclude the false negative reports resulted from antibiotic misuse or abuse.