新世代流式細胞儀UF-5000以及UF-1000i用於非複雜性泌尿道感染預測細菌生長效度之效度比較
趙梓辰1、楊淳淳2、張尚仁1、楊緒棣1
1台北慈濟醫院 泌尿科，2檢驗醫學科
Comparison of the efficacy of new laser flow cytometry UF-5000 with UF-1000i in predicting bacteria growth patterns in patients with uncomplicated urinary tract infections
Tze-Chen Chao1, Chun-Chun Yang2, Shang-Jen Chang1, Stephen Shei-Dei Yang1
1Division of Urology and 2Division of General Laboratory, Taipei Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
Purpose: We prospectively evaluate the ability of the new flow cytometry UF-5000 with UF-1000i in predicting the bacterial patterns in urine samples obtained from community women with uncomplicated urinary tract infection (UTI).
Materials and Methods: From July 1, 2016 to June 30, 2019, women aged 20-80 years who visited urological clinics with symptoms suggestive of UTI would be invited to fill the questionnaire with Urinary Tract Symptoms Assessment questionnaire (UTISA). Patients with UTISA score 4 or more were invited to join the study and those with urolithiasis, pregnancy, recent antibiotics use, neurogenic bladder or with urine catheter were excluded. After signed informed consent and completion of a questionnaire for baseline characteristics, mid-stream urine sample was collected for gram staining, urine analysis and urine culture. Urine analyses were performed with the both models of laser flow cytometry (UF1000i and UF 5000 Sysmex, Kobe, Japan). Trough the diagams generated from laser flow cytometry, specimen was classified as none, cocci bacteria or rods/mixed growth in UF1000i. For UF 5000 and gram staining, specimen was classified as none, cocci, rods or mixed growth. Standard urine cultures were performed, and the agreement between cultures and the UF1000i/UF5000/gram staining interpretations was analyzed.
Results: Finally, 102 samples from 102 women (age: 49.6 ± 16.6 years) with UTISA score of 10.7 ± 3.8 met the criteria for analysis. Among these samples, there were 10 gram-positive cocci, 2 gram-positive bacilli, 66 gram-negative rods, and 24 specimens with two bacteria species or more that were regarded as mixed growth. Gram-positive bacilli were excluded for analysis of agreement. The sensitivity/specificity of UF-1000i was 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of UF-5000 was 80.0%/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci. Using kappa statistics, agreement of urine culture /UF5000 and urine culture/Gram staining valued 0.459 and 0.481, which the grades were both moderate according to Altman’s suggestions. Using kappa statistics, agreement of urine culture /UF5000 and urine culture/Gram staining valued 0.459 and 0.481, which the grades were both moderate according to Altman’s suggestions.
Conclusions: UF-5000 demonstrated potential utility for the rapid screening of bacterial morphology, which inherited the well sensitivity and specificity of UF1000i for GNB bacteria and improve the sensitivity for detecting the Gram-positive cocci bacteria had had equivalent agreement strength comparing with gram staining.