《尿路感染全球多学科诊断标准共识》解读

doi:10.3969/j.issn.1006-5725.2025.18.001

Abstract

Abstract:

The clinical diagnosis and treatment of urinary tract infection has long faced the challenges of insufficient standardization of diagnosis and treatment pathways， irrational use of antimicrobial drugs and high recurrence rate. How to optimize the hierarchical diagnosis and treatment pathway of urinary tract infection， standardize the use of antimicrobial drugs， and reduce the recurrence rate have always been the focus of clinical attention. There is significant heterogeneity in the existing diagnostic criteria for urinary tract infection， which seriously affects the comparability and evidence integration of clinical and research studies. In order to solve the above problems， a consensus on global multidisciplinary diagnostic criteria for urinary tract infection has been formed by international multidisciplinary experts after three rounds of Delphi method. Breaking through the traditional classification framework， the consensus innovatively established a four-dimensional quantitative scoring system including local symptoms and signs， systemic inflammatory response， quantitative analysis of pyuria and urine culture results， and established a hierarchical standard for stepwise urinary tract diagnosis according to the scoring threshold. Based on the key citations related to the consensus， this paper interprets in detail the basis for the selection of core indicators and the establishment of thresholds for the diagnosis of urinary tract infection in the consensus， and focuses on the key issues and implementation paths of the consensus in localization practice. This consensus provides a unified standard for standardizing the clinical diagnosis and treatment of urinary tract infection， improving the homogeneity of clinical research through standardized diagnostic processes， and promoting the standardization of UTI drug research and development and the rational use of antibiotics and precision.

Key words: urinary tract infections, consensus on global multidisciplinary diagnostic criteria, localization practice, diagnostic process, clinical diagnosis and treatment

CLC Number:

R604

Guofen LIANG,Zhenhua YANG,Yibo WANG,Kaiyu HE,La ZHANG,Xusheng LIU,Yueyu GU,Xindong QIN,Guobin SU. Interpretation of 《Global consensus on multidisciplinary diagnostic criteria for urinary tract infections》[J]. The Journal of Practical Medicine, 2025, 41(18): 2777-2785.

Figures/Tables 3

Tab.1

Fig.1

Tab.2

Global urinary tract infection scoring system"

领域	具体内容	评分				维度要点
领域	具体内容	3分	2分	1分	0分	维度要点
局部症状与体征	（1）主要：排尿困难、尿频、尿急；（2）次要：耻骨上疼痛或压痛、胁腹疼痛或压痛、会阴疼痛或前列腺检查疼痛、尿失禁、肉眼血尿、症状识别^*。	2种或2种以上新发主要症状，如果女性患者年龄≥ 65岁则加1分。	（1）1种新出现的主要症状；（2）2种新出现的次要症状。	（1）1种新发的次要症状；（2）无法表达或感知症状，如因谵妄、痴呆或脊髓损伤而无法表达。		新发的排尿困难、尿频和尿急是UTI的最常见征兆。
全身炎症反应	（1）发热，温度为38.0 ℃或100.4 °F；（2）C反应蛋白浓度≥ 50 mg/L；（3）降钙素原浓度≥ 0.5 ng/mL；（4）血白细胞计数≥ 12 × 10⁹/L；（5）菌血症，与尿培养相同的病原体。		1条及以上新发的全身表现。		没有全身表现。	区分有和无全身受累的尿路感染，并避免使用“复杂性尿路感染”一词。
脓尿定量分析	在中段尿或通过一次性的导尿管获取的尿液样本中	（1）尿白细胞≥ 200个/μL；（2）尿白细胞≤ 50个/hpf	（1）尿白细胞10 ~ 200个/μL；（2）尿白细胞≥ 5 ~ 50个/hpf，若女性患者年龄≥ 65岁则减1分。			引入尿白细胞200个/μL的新阈值来识别是否具有临床意义
中段尿液培养	尿源性病原体：肠杆菌、铜绿假单胞、腐生葡萄球菌。	（1）1种或2种尿源性病原体，其中：①中段尿≥ 10⁴ CFU/mL；②通过一次性导尿管获取的尿液样本≥ 10³ CFU/mL；③若检出大肠杆菌则≥ 10³ CFU/mL；以上若女性患者年龄≥ 65岁则减1分）（2）菌血症，与尿培养相同的病原体。		（1）混合菌群；（2）其他病原体；（3）已使用抗生素后无病原体生长。	（1）未使用抗生素预处理的情况下，未观察到病原体生长；（2）未进行中段尿培养。	（1）鼓励进行尿液培养；（2）中段尿液样本应用10⁴ CFU/mL的阈值；（3）通过一次性导尿管获取的尿液样本≥ 10³ CFU/mL；（4）如果培养出大肠杆菌，则应用10³ CFU/mL的阈值。

Tab.2

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Interpretation of 《Global consensus on multidisciplinary diagnostic criteria for urinary tract infections》

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