Clinical features to identify urinary tract infection in nursing home residents: a cohort study.
Clinical features to identify urinary tract infection in nursing home residents: a cohort study.
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DOI：
10.1111/j.1532-5415.2009.02227.x
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发表时间：
2009-06
影响因子：
6.3
通讯作者：
Tinetti M
中科院分区：
文献类型：
--
作者：
Juthani-Mehta M;Quagliarello V;Perrelli E;Towle V;Van Ness PH;Tinetti M
在临床怀疑为尿路感染的非留置尿管疗养院居民中，确定与菌尿和脓尿相关的临床特征。2005至2007年的前瞻性观察性队列研究。五家康涅狄格州纽黑文地区疗养院。551名养老院居民每人随访一年，以了解临床疑似尿路感染的发生情况。菌尿(尿培养100,000个集落形成单位)和脓尿(尿分析10个白细胞)的综合结果。在178,914个人日的随访中，228名参与者有399次临床疑似尿路感染，并进行了尿液分析和尿培养；147次(37%)有菌尿和脓尿。临床表现为排尿困难(相对危险度RR=1.58，95%可信区间为1.10，2.03)，尿液性质改变(RR=1.42，95%CI为1.07，1.79)，精神状态改变(RR=1.38，95%CI为1.03，1.74)。排尿困难、尿液性质改变和精神状态改变与菌尿和脓尿的综合结果显著相关。缺乏这些临床特征的居民患菌尿加脓尿的风险较低(25%)，而出现排尿困难加上其他临床特征中的一种或两种时，居民患菌尿加脓尿的风险较高(63%)。对于大多数只符合一个临床特征的居民来说，诊断的不确定性仍然存在。如果在未来的队列中得到证实，这些有菌尿和脓尿的临床特征可能会作为UTI的循证临床定义，以帮助管理决策。
To identify, among non-catheterized nursing home residents with clinically suspected UTI, clinical features associated with bacteriuria plus pyuria. Prospective, observational cohort study from 2005 to 2007. Five New Haven, CT area nursing homes. 551 nursing home residents each followed for one year for the development of clinically suspected UTI. The combined outcome of bacteriuria (>100,000 colony forming units on urine culture) plus pyuria (>10 white blood cells on urinalysis). After 178,914 person-days of follow-up, 228 participants had 399 episodes of clinically suspected UTI with a urinalysis and urine culture performed; 147 episodes (37%) had bacteriuria plus pyuria. The clinical features associated with bacteriuria plus pyuria were dysuria (relative risk [RR]=1.58, 95% confidence interval [CI] 1.10, 2.03), change in character of urine (RR=1.42, 95% CI 1.07, 1.79), and change in mental status (RR=1.38, 95% CI 1.03, 1.74). Dysuria, change in character of urine, and change in mental status were significantly associated with the combined outcome of bacteriuria plus pyuria. Absence of these clinical features identified residents at low risk of having bacteriuria plus pyuria (25%), while presence of dysuria plus one or both of the other clinical features identified residents at high risk of having bacteriuria plus pyuria (63%). Diagnostic uncertainty still remains for the vast majority of residents who meet only one clinical feature. If validated in future cohorts, these clinical features with bacteriuria plus pyuria may serve as an evidence-based clinical definition of UTI to assist in management decisions.
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影响因子：
5.7
作者：
Loeb, M;Simor, AE;McGeer, A
通讯作者：
McGeer, A
DOI：
10.1111/j.1532-5415.2005.00470.x
发表时间：
2005-11-01
影响因子：
6.3
作者：
Juthani-Mehta, M;Drickamer, MA;Quagliarello, VJ
通讯作者：
Quagliarello, VJ
影响因子：
--
作者：
Loeb, M;Brazil, K;Walter, SD
通讯作者：
Walter, SD
影响因子：
4.5
作者：
Juthani-Mehta, Manisha;Tinetti, Mary;Quagliarello, Vincent
通讯作者：
Quagliarello, Vincent
DOI：
10.1111/j.1532-5415.2007.01217.x
发表时间：
2007-07-01
影响因子：
6.3
作者：
Juthani-Mehta, Manisha;Tinetti, Mary;Quagliarello, Vincent
通讯作者：
Quagliarello, Vincent