Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home residents

OBJECTIVES: To prospectively evaluate nursing home residents with suspected urinary tract infection (UTI) to determine whether they met the McGeer, Loeb, or revised Loeb consensus-based criteria and whether any set of criteria was associated with laboratory evidence of UTI, namely bacteriuria (>100,000 colony forming units) plus pyuria (>10 white blood cells). DESIGN: Prospective cohort study. SETTING: Three New Haven-area nursing homes. PARTICIPANTS: Of 611 residents screened, 457 were eligible, 362 consented, and 340 enrolled. MEASUREMENTS: Participants underwent prospective surveillance from May 2005 to April 2006 for the development of suspected UTI (defined as a participant's physician or nurse clinically suspecting UTI). One hundred participants with suspected UTI and a urinalysis and urine culture performed were included in the analyses. RESULTS: Participants were identified who met the criteria of McGeer, Loeb, revised Loeb, and laboratory evidence of UTI. Using laboratory evidence of UTI as the outcome, the McGeer criteria demonstrated 30% sensitivity, 82% specificity, 57% positive predictive value (PPV), and 61% negative predictive value (NPV); the Loeb criteria showed 19% sensitivity, 89% specificity, 57% PPV, and 59% NPV; and the revised Loeb criteria demonstrated 30% sensitivity, 79% specificity, 52% PPV, and 60% NPV. CONCLUSION: All of the consensus-based criteria have similar test characteristics. The diagnostic accuracy of UTI criteria in nursing home residents could be improved, and the data suggest that evidence-based clinical criteria associated with laboratory evidence of UTI need to be identified and validated.     

Inpatient healthcare‐associated bloodstream infections in older people

This retrospective study describes inpatient healthcare‐associated bloodstream infections (HABSI) in older adults and explores whether urinary catheters (presence/insertion/removal) were related to HABSI events. One hundred and sixty‐seven HABSI events were identified, predominantly (124, 74%) with Gram‐negative bacteria. HABSI was attributed to a urinary source in 110 patients (66%), with over half (63, 57%) of these associated with urinary catheters. Catheter‐associated HABSI may be avoidable and potential preventative strategies are discussed.     

Nursing home practitioner survey of diagnostic criteria for urinary tract infections

OBJECTIVES: To identify clinical and laboratory criteria used by nursing home practitioners for diagnosis and treatment of urinary tract infections (UTIs) in nursing home residents. To determine practitioner knowledge of the most commonly used consensus criteria (i.e., McGeer criteria) for UTIs. DESIGN: Self-administered survey. SETTING: Three New Haven-area nursing homes. PARTICIPANTS: Physicians (n=25), physician assistants (PAs, n=3), directors/assistant directors of nursing (n=8), charge nurses (n=37), and infection control practitioners (n=3). MEASUREMENTS: Open- and closed-ended questions. RESULTS: Nineteen physicians, three PAs, and 41 nurses completed 63 of 76 (83%) surveys. The five most commonly reported triggers for suspecting UTI in noncatheterized residents were change in mental status (57/63, 90%), fever (48/63, 76%), change in voiding pattern (44/63, 70%), dysuria (41/63, 65%), and change in character of urine (37/63, 59%). Asked to identify their first diagnostic step in the evaluation of UTIs, 48% (30/63) said urinary dipstick analysis, and 40% (25/63) said urinalysis and urine culture. Fourteen of 22 (64%) physicians and PAs versus 40 of 40 (100%) nurses were aware of the McGeer criteria for noncatheterized patients (P<.001); 12 of 22 (55%) physicians and PAs versus 38 of 39 (97%) nurses used them in clinical practice (P<.001). CONCLUSION: Although surveillance and treatment consensus criteria have been developed, there are no universally accepted diagnostic criteria. This survey demonstrated a distinction between surveillance criteria and criteria practitioners used in clinical practice. Prospective data are needed to develop evidence-based clinical and laboratory criteria of UTIs in nursing home residents that can be used to identify prospectively tested treatment and prevention strategies.     

住院2型糖尿病患者合并尿路感染危险因素分析

目的：分析住院2型糖尿病患者尿路感染的患病情况及其临床特点,并探讨2型糖尿病患者合并尿路感染的危险因素。方法回顾性地分析香港大学深圳医院2013年10月至2014年9月内分泌与代谢科住院的2型糖尿病患者共249例,收集相应临床资料,比较尿路感染组与非感染组患者年龄、性别、体质量指数、糖尿病病程、糖化血红蛋白（HbA1c）、估算肾小球滤过率（eGFR）、肌酐、尿微量白蛋白/肌酐（ACR）、24h尿微量白蛋白定量、尿糖等指标的异同,分析2型糖尿病患者合并尿路感染的危险因素。结果住院2型糖尿病患者合并尿路感染的患病率为16.1%;年龄、性别、eGFR、ACR、24h尿微量白蛋白定量、肌酐在两组之间差异具有统计学意义（P＜0.05）,女性、年龄越大、肾功能越差、尿微量白蛋白越多的患者越易合并尿路感染。而尿糖、糖尿病病程、HbA1c、体质量指数在各组之间差异无统计学意义。logistic回归分析显示性别、肌酐是尿路感染的独立危险因素。结论2型糖尿病患者合并尿路感染与性别、肌酐相关,女性、肾功能不良的患者是高危人群。     

Residual urine as a risk factor for lower urinary tract infection: a 1-year follow-up study in nursing homes

OBJECTIVES: To determine whether postvoid urine is a risk factor for the development of lower urinary tract infections (UTIs) in nursing home residents.
DESIGN: Prospective surveillance with a follow-up period of 1 year.
SETTING: Six Norwegian nursing homes.
PARTICIPANTS: One hundred fifty nursing home residents.
METHODS: Postvoid residual (PVR) urine volumes were measured using a portable ultrasound. UTIs were registered prospectively for 1 year.
RESULTS: Ninety-eight residents (65.3%) had a PVR less than 100 mL, and 52 (34.7%) had a PVR of 100 mL or greater. During the follow-up period, 51 residents (34.0%) developed one or more UTIs. The prevalence of UTI in women was higher than in men (40.4% vs 19.6%; P =.02). There was no significant difference in mean PVR between residents who did and did not develop a UTI (79 vs 97 mL, P =.26). PVR of 100 mL or greater was not associated with greater risk of developing a UTI ( P =.59).
CONCLUSION: High PVR is common in nursing home residents. No association between PVR and UTI was found.     

Gut commensal microbiota and decreased risk for Enterobacteriaceae bacteriuria and urinary tract infection

ABSTRACT

Urinary tract infection (UTI) is a common complication in kidney transplant recipients and can lead to significant morbidity and mortality. Recent evidence supports a role for the gut as a source for UTIs but little is known about the relationship between gut commensal bacteria and UTI development. We hypothesized that the abundance of gut commensal bacteria is associated with a lower risk of developing bacteriuria and UTIs. We performed gut microbiome profiling using 16S rRNA gene sequencing of the V4-V5 hypervariable region on 510 fecal specimens in 168 kidney transplant recipients. Fifty-one kidney transplant recipients (30%) developed Enterobacteriaceae bacteriuria within the first 6 months after transplantation (Enterobacteriaceae Bacteriuria Group) and 117 did not (No Enterobacteriaceae Bacteriuria Group). The relative abundances of Faecalibacterium and Romboutsia were significantly higher in the fecal specimens from the No Enterobacteriaceae Bacteriuria Group than those from the Enterobacteriaceae Bacteriuria Group (Adjusted P value<.01). The combined relative abundance of Faecalibacterium and Romboutsia was inversely correlated with the relative abundance of Enterobacteriaceae (r = ?0.13, P = .003). In a multivariable Cox Regression, a top tercile cutoff of the combined relative abundance of Faecalibacterium and Romboutsia of ≥13.7% was independently associated with a decreased risk for Enterobacteriaceae bacteriuria (hazard ratio 0.3, P = .02) and Enterobacteriaceae UTI (hazard ratio 0.4, P = .09). In conclusion, we identify bacterial taxa associated with decreased risk for Enterobacteriaceae bacteriuria and Enterobacteriaceae UTI in kidney transplant recipients, which supports future studies on modulating the gut microbiota as a novel treatment for preventing UTIs.     

Point‐of‐use water filtration reduces healthcare‐associated infections in bone marrow transplant recipients

J.S. Cervia, B. Farber, D. Armellino, J. Klocke, R.‐L. Bayer, M. McAlister, I. Stanchfield, F.P. Canonica, G.A. Ortolano. Point‐of‐use water filtration reduces healthcare‐associated infections in bone marrow transplant recipients.
Transpl Infect Dis 2010: 12: 238–241. All rights reserved Abstract: Outbreaks of infection with gram‐negative bacteria (GNB) have been linked to hospital water. We sought to determine whether point‐of‐use (POU) water filtration might result in decreased risk of infection in hospitalized bone marrow transplant (BMT) recipients in the absence of any recognized outbreak. Unfiltered water was sampled from taps in the BMT unit of a major US teaching hospital, and cultured at a reference laboratory. POU bacterial‐retentive filters (0.2 μm) were installed throughout the unit, and replaced every 14 days. Infection rates were tracked over a 9‐month period, and compared with rates for a 16‐month period before POU filtration. Unfiltered water samples from 50% (2 of 4) outlets sampled grew P. aeruginosa (2 of 4) and Stenotrophomonas maltophilia (1 of 4). Clinical infection rates in the unit were significantly reduced from 1.4 total and 0.4 GNB infections per 100 patient days in the period before POU filtration to 0.18 total and 0.09 GNB infections per 100 patient days (P=0.0068 and 0.0431, respectively) in the 9‐month period for which filters were in place. Infections during the POU filtration period were due to non‐waterborne organisms. Point‐of‐use (POU) water filtration may significantly reduce infection rates in BMT recipients in the absence of any recognized outbreak.     

Risk factors for urinary infection after retrograde upper urinary lithotripsy: Implication for nursing

There are needs to evaluate the risk factors for urinary infection after retrograde upper urinary lithotripsy, to provide insights into the management and nursing care of patients with retrograde upper urinary lithotripsy.Patients who received retrograde upper urinary lithotripsy with a Foley 20 urinary tube insertion from June 1, 2019 to December 31, 2020 in our hospital were selected. Patients were grouped urinary infection and no infection group according to the culture results of urine, and the clinical data of the 2 groups of patients were collected and compared. Single factor and logistic regression analysis were used to analyze the risk factors of urinary tract infection after retrograde upper urinary lithotripsy.Four hundred ten patients with retrograde upper urinary lithotripsy were included, of whom 62 patients had the urinary tract infection, the incidence of urinary tract infection was 15.12%. There were significant differences in the gender, age, diabetes, stone diameter, duration of urinary tube insertion and duration of surgery between infection and no-infection group (all P < .05). The Escherichia coli (62.90%) was the most commonly seen bacterial in patients with urinary tract infection. Female (odds ratio [OR]: 1.602, 95% confidence interval 95% [CI]: 1.132∼2.472), age >50 years (OR: 2.247, 95% CI: 1.346∼3.244), diabetes (OR: 2.228, 95% CI: 1.033∼3.451), stone diameter ≥2 cm (OR: 2.152, 95% CI: 1.395∼3.099), duration of urinary tube insertion ≥3 days (OR: 1.942, 95% CI:1.158∼2.632), duration of surgery ≥90 minutes (OR: 2.128, 95% CI: 1.104∼3.846) were the independent risk factors for the postoperative urinary tract infection in patients with retrograde upper urinary lithotripsy (all P < .05).The incidence of urinary tract infection in patients undergoing retrograde upper urinary lithotripsy was high, counteractive measures targeted on those risk factors are needed to prevent and reduce the postoperative urinary infection in clinical settings.     

Day‐care service use is a risk factor for long‐term care placement in community‐dwelling dependent elderly

Aims: To identify predictors of long‐term care placement and to examine the effect of day‐care service use on long‐term care placement over a 36‐month follow‐up period among community‐dwelling dependent elderly. Methods: This study was a prospective cohort analysis of 1739 community‐dwelling elderly and 1442 caregivers registered in the Nagoya Longitudinal Study for Frail Elderly. Data included the clients' demographic characteristics, basic activities of daily living, comorbidities, and use of home care services, including the day‐care, visiting nurse, and home‐help services, as well as caregivers' demographic characteristics and care burden. Analysis of long‐term care placement over 36 month was conducted using Kaplan–Meier curves and multivariate Cox proportional hazards models. Results: Among the 1739 participants, 217 were institutionalized at long‐term care facilities during the 36‐month follow‐up. Multivariate Cox regression models, adjusted for potential confounders, showed that day‐care service use was significantly associated with an elevated risk for long‐term care placement within the 36‐month follow‐up period. Participants using a day‐care service two or more times/week had significantly higher relative hazard ratios than participants not using such a service. Conclusion: The results highlight the need for effective measures to reduce the long‐term care placement of day‐care service users. Policy makers and practitioners must consider implementing multidimensional support programs to reduce the caregivers' willingness to consider long‐term care placement. Geriatr Gerontol Int 2012; 12: 322–329.     

Health care‐associated infections are associated with increased length of stay and cost but not mortality in children undergoing cardiac surgery

Introduction: Health care‐associated infections (HAIs) increase mortality, length ofstay, and cost in hospitalized patients. The incidence of and risk factors for developing HAIs in the pediatric population after cardiac surgery have been studied. Thisstudy evaluates the impact of HAIs on length of stay, inpatient mortality, and cost ofhospitalization in the pediatric population after cardiac surgery.
Methods: TheKids’InpatientDatabasewasqueriedforanalysis.Patientsunder18yearsof age who underwent cardiac surgery from 1997 to 2012 were included. HAIs weredefined as central line‐associated blood stream infections, catheter‐associated urinarytract infections, ventilator‐associated pneumonias, and surgical wound infections.Univariate analysis compared admissions with and without a HAI. Next, regressionanalysis was done to determine patient factors independently associated with a HAI,and to determine what specific HAIs were independently associated with our primary outcomes.
Results: In total 46 169 admissions were included, 773 (1.6%) of which had a HAI.Regression analysis showed younger age (P < .001), heart failure (OR 1.2, 95% CI1.1‐1.4, P = .03), and acute kidney injury (AKI; 2.7, 2.0‐3.6, P < .001), among otherswere all independently associated with a HAI.The presence of HAI was associated with increased length of stay (median 29 vs6 days, P < .001), total cost (median $271 884 vs $88 385, P < .001), and inpatientmortality (6.1% vs 2.5%, P < .001) by univariate analysis. Regression analysis demonstrated that each HAI were independently associated with increased length of stayand increased total charges for the hospital stay. However, HAI, was not associatedwith increased mortality after regression analysis.
Conclusions: The incidence of HAIs in this analysis was low (1.6%) but contributedsignificantly to length of stay and cost. No individual HAI was associated with increasedmortality. Potential modifiable risk factors include age and prevention of AKI.