尿沉渣革兰染色镜检在尿路感染诊断中的价值

Diagnostic value of urine sediment gram staining microscopy in urinary tract infection

目的:研究尿沉渣革兰染色镜检对尿路感染的诊断价值。方法:分析2021年8月-2021年12月632例送检清洁中段尿培养的门诊及住院患者结果,以临床诊断作为金标准,分析尿沉渣革兰染色镜检对尿路感染的诊断性能。结果:632例患者标本中尿培养阳性218例(34.5%),尿路感染最常见的病原菌为大肠埃希菌,其次为肠球菌属和葡萄球菌属。白细胞、菌量、尿培养的诊断比值比均大于1,白细胞的诊断比值比最高,菌量和尿培养的诊断比值比近似。以白细胞少量为诊断尿路感染的阈值,灵敏度和特异度均较高(分别为88%,79%),约登指数最大(0.67),诊断比值比最高(29.20)。尿沉渣革兰染色镜检观察到的病原菌形态学特征与培养结果一致。结论:尿沉渣革兰染色镜检作为一种快速筛查实验,在尿路感染诊断中具有较高临床价值。

Objective:To investigate the clinical value of urine sediment gram staining microscopy in the diagnosis of urinary tract infection(UTI).Methods:A totally of 632 cases which were performed the midstream urine bacterial culture for outpatients and hospitalized patients from Aug.2021 to Dec.2021 were analyzed.And the performances of urine sediment gram staining microscopy in screening UTI was evaluated with the clinical diagnosis as the golden standard.Results:218(34.5%)of the 632 patients were positive in urine culture.UTI are caused by a range of pathogens,but most commonly by Enterobactericaeae,especially Escherichia coli,followed by Enterococus,Staphylococcus.Evaluating the performance of the various indexes in screening UTI,the diagnostic odds ratio(DOR)of WBC,bacterial count and urine culture were all greater than 1.The DOR of WBC was the highest,the DOR of bacterial count and urine culture were similar.Small amount of WBC as threshold for the diagnosis of UTI,the sensitivity and specificity were both high(88%and 79%,respectively),the Youden index was the largest(0.67),and the DOR was the highest(29.20).The morphological characteristics of pathogenic bacteria observed by urine sediment gram staining microscopy were consistent with the culture results.Conclusion:As a rapid screening experiment,urine sediment gram staining microscopy has high clinical value in diagnosing of UTI.