How Often Do Clinically Diagnosed Catheter-Associated Urinary Tract Infections in Nursing Homes Meet Standardized Criteria?
How Often Do Clinically Diagnosed Catheter-Associated Urinary Tract Infections in Nursing Homes Meet Standardized Criteria?
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DOI：
10.1111/jgs.14533
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发表时间：
2017-02
影响因子：
6.3
通讯作者：
Mody L
中科院分区：
文献类型：
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作者：
Armbruster CE;Prenovost K;Mobley HL;Mody L
确定临床诊断的导管相关性尿路感染(CAUTI)与标准化标准的关系，并在一组导尿式养老院(NH)居民中评估症状负担的微生物水平差异。前瞻性纵向研究的后处理分析。密歇根州东南部的12个国民健康保险制度。233名NH居民留置导尿管。临床和人口学数据，包括CAUTI流行病学和症状，在研究登记时获得，14天，然后每月获取，最长为一年。120名留置导尿管的参与者(51%)在182例临床诊断为CAUTIs的患者中被开出全身抗生素。参与者主要是白人(90%)，男性(52%)，平均年龄73.7岁。常见的体征和症状是精神状态的急性变化(28%)、发热(21%)和白细胞增多(13%)。临床诊断的CAUTIs中，40%符合Loeb的最低标准，32%符合国家健康安全网(NHSN)标准，50%符合Loeb的最低标准或NHSN标准。金黄色葡萄球菌和肠球菌的CAUTIS。是最不可能达到标准的。涉及肺炎克雷伯菌的CAUTI最有可能符合Loeb的最低标准(OR=9.7[95%CI，2.3-40.3])，可能是因为与精神状态的急性变化有关(OR=5.9[95%CI，1.8-19.4])。50%的临床诊断的CAUTIs符合标准化标准，这代表着抗生素处方实践的改善。在微生物水平上，我们的探索性数据表明，不同微生物的症状负担可能不同。探索与特定微生物相关的CAUTI迹象和症状可能会产生有益的信息，以完善指导适当抗生素治疗的现有工具。
Determine the relationship of clinically diagnosed catheter-associated urinary tract infection (CAUTI) to standardized criteria and assess microorganism-level differences in symptom burden in a cohort of catheterized nursing home (NH) residents. Post-hoc analysis of a prospective longitudinal study. Twelve NHs in Southeast Michigan. 233 NH residents with indwelling urinary catheters. Clinical and demographic data, including CAUTI epidemiology and symptoms, were obtained at study enrollment, 14 days, and monthly thereafter for up to one year. One hundred twenty participants with an indwelling catheter (51%) were prescribed systemic antibiotics for 182 clinically diagnosed CAUTIs. Participants were predominantly white (90%), male (52%), with a mean age of 73.7 years. Common signs and symptoms were acute change in mental status (28%), fever (21%), and leukocytosis (13%). Forty percent of clinically diagnosed CAUTIs met Loeb’s minimum criteria, 32% met National Health Safety Network (NHSN) criteria, and 50% met either Loeb’s minimum or NHSN criteria. CAUTIs involving Staphylococcus aureus and Enterococcus spp. were least likely to meet criteria. CAUTIs involving K. pneumoniae were most likely to meet Loeb’s minimum criteria (OR=9.7 [95% CI, 2.3–40.3]), possibly due to an association with acute change in mental status (OR=5.9 [95% CI, 1.8–19.4]). Fifty percent of clinically diagnosed CAUTIs met standardized criteria, which represents an improvement in antibiotic prescribing practices. At the microorganism-level, our exploratory data indicates that symptom burden may differ between microorganisms. Exploration of CAUTI signs and symptoms associated with specific microorganisms may yield beneficial information to refine existing tools guiding appropriate antibiotic treatment.