Clinical Features in Nursing Home Residents with Suspected UTI

描述(申请人提供)：尿路感染(UTI)是疗养院居民开抗生素最常见的适应症。到目前为止，疗养院居民尿路感染的监测、诊断和治疗标准是通过共识而不是经验数据得出的。缺乏经验证据的标准使疗养院从业者面临共同的临床困境，即确定非特定的临床变化(如发烧、精神状态改变)是否可归因于尿路感染，以及治疗是否有利于临床结果。确定谁应该接受抗生素的关键一步是经验性地确定诊断标准，包括临床和实验室特征。这一系列调查的长期目标是确定有尿路感染实验室证据(即菌尿和脓尿)的疗养院居民中，抗生素治疗可减少不良后果(即菌血症、功能下降、死亡)的人群。这项拟议研究的具体目的是确定与尿路感染实验室证据(细菌尿[尿培养100,000个菌落形成单位]和脓尿[尿分析10个白细胞])相关的临床特征。我们的先验假设是，特定的临床特征(即精神状态的变化、发烧、排尿方式的变化)将与尿路感染的实验室证据相关联。这项观察性队列研究将在纽黑文地区的五家养老院进行，样本量估计为493名居民。65岁或以上的人将在登记时接受基线评估，并在怀疑患有尿路感染时进行重复评估。Logistic回归模型将用于确定尿路感染的临床特征和实验室证据之间的双变量和多变量关联。ROC曲线将从最终的多变量Logistic回归模型计算出来。这些独立于尿路感染实验室证据的临床特征将与菌尿和脓尿相结合，以创建基于证据的尿路感染定义。确定疗养院居民的临床相关UTI是一个常见的两难问题，具有重要的功能、经济和感染控制意义。这项研究将创建一个以证据为基础的UTI定义。未来的研究将确定有尿路感染的居民，在这些患者中，抗生素治疗可以改善临床结果。

DESCRIPTION (provided by applicant): Urinary tract infection (UTI) is the most common indication for prescribing antibiotics in nursing home residents. To date, criteria for surveillance, diagnosis, and treatment of UTI in nursing home residents have been derived by consensus rather than empirical data. Lack of criteria from empirical evidence leaves nursing home practitioners with the common clinical dilemma of deciding whether nonspecific clinical changes (e.g., fever, altered mental status) are attributable to UTI and whether treatment will benefit clinical outcome. A key step to identifying who should receive antibiotics is to empirically determine diagnostic criteria, including both clinical and laboratory features. The long-term OBJECTIVE of this line of investigation is to identify the subset of nursing home residents with laboratory evidence of UTI (i.e., bacteriuria plus pyuria) in which antibiotic therapy reduces adverse outcomes (i.e., bacteremia, functional decline, death). The SPECIFIC AIM of this proposed research is to identify clinical features that are associated with laboratory evidence of UTI (bacteriuria [>100,000 colony forming units on urine culture] plus pyuria [>10 white blood cells on urinalysis]). Our a priori HYPOTHESIS is that specific clinical features (i.e., change in mental status, fever, change in voiding pattern) will be associated with laboratory evidence of UTI. This observational cohort study will be conducted at five New Haven area nursing homes with a sample size estimate of 493 residents. Persons aged 65 years or older will undergo baseline assessment upon enrollment and repeat assessment when suspected of having UTI. A logistic regression model will be used to determine bivariate and multivariable associations between clinical features and laboratory evidence of UTI. A ROC curve will be calculated from the final multivariable logistic regression model. Those clinical features independently associated with laboratory evidence of UTI will be combined with bacteriuria and pyuria to create an evidence-based definition of UTI. Identifying clinically relevant UTI in nursing home residents is a common dilemma with important functional, economic, and infection control implications. This study will create an evidence-based definition of UTI. Future studies will identify residents with UTI in whom antibiotic therapy improves clinical outcome.