Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home resident
Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home resident
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DOI：
10.1111/j.1532-5415.2007.01217.x
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发表时间：
2007-07-01
影响因子：
6.3
通讯作者：
Quagliarello, Vincent
中科院分区：
文献类型：
--
作者：
Juthani-Mehta, Manisha;Tinetti, Mary;Quagliarello, Vincent
目的：前瞻性评估疑似尿路感染（UTI）的疗养院居民，以确定他们是否符合McGeer、Loeb或修订的Loeb共识标准，以及是否有任何一组标准与UTI的实验室证据（即菌尿）相关（> 100，000菌落形成单位）+脓尿（> 10个白色血细胞）。设计：前瞻性队列研究。地点：三个纽黑文地区的疗养院。参与者：611居民筛选，457人有资格，362同意，340 enrolled.MEASUREMENTS：参与者进行了前瞻性监测，从2005年5月至2006年4月的发展可疑UTI（定义为参与者的医生或护士临床怀疑UTI）。100名参与者与疑似尿路感染和尿液分析和尿培养进行了included in the analysis.Results：参与者被确定谁符合标准的McGeer，勒布，修订勒布，和实验室证据的尿路感染。以UTI的实验室证据作为结果，McGeer标准显示30%的敏感性、82%的特异性、57%的阳性预测值（PPV）和61%的阴性预测值（NPV）; Loeb标准显示19%的敏感性、89%的特异性、57%的PPV和59%的NPV;修订Loeb标准的敏感性为30%，特异性为79%，PPV为52%，NPV为60%。结论：所有基于共识的标准具有相似的测试特征。UTI标准在养老院居民中的诊断准确性可以提高，数据表明，与UTI的实验室证据相关的循证临床标准需要确定和验证。
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.