Clinical Features in Nursing Home Residents with Suspected UTI

疑似尿路感染的疗养院居民的临床特征

• 批准号: 7201957
• 负责人: MANISHA JUTHANI-MEHTA
• 金额: $ 6.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-03-01 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7201957
• 关键词: Acute; Adopted; Adult; Adverse drug effect; Age; Antibiotic Therapy; Antibiotic-resistant organism; Antibiotics; Area; Bacteremia; Bacteria; Bacterial Infections; Bacteriuria; Cessation of life; Chronic; Clinical; Cohort Studies; Colony-forming units; Communicable Diseases; Consensus; Data; Diagnosis; Diagnostic; Dysuria; Economics; Enrollment; Fever; Future; Genitourinary system; High Prevalence; Impaired cognition; Incidence; Infection; Infection Control; Inflammation; Investigation; Kidney Failure; Laboratories; Left; Leukocytes; Literature; Logistic Regressions; Medical Surveillance; Modeling; Morbidity - disease rate; Nurses; Nursing Homes; Outcome; Outcome Measure; Pain; Pattern; Persons; Physicians; Population; Psyche structure; Publishing; Pyuria; ROC Curve; Randomized Controlled Trials; Recommendation; Renal Hypertension; Reporting; Research; Risk; Sample Size; Sepsis; Source; Standards of Weights and Measures; Surveys; Symptoms; Urinalysis; Urinary tract; Urinary tract infection; Urination; Urine; base; clinically relevant; cohort; day; experience; functional decline; improved; mortality; young adult

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.

描述（由申请人提供）：尿路感染（UTI）是养老院居民开抗生素最常见的适应症。迄今为止，疗养院居民尿路感染的监测、诊断和治疗标准都是通过共识而不是经验数据得出的。由于缺乏来自经验证据的标准，养老院从业人员在确定非特异性临床变化（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方面面临着常见的临床困境。确定谁应该接受抗生素治疗的关键步骤是根据经验确定诊断标准，包括临床和实验室特征。这项调查的长期目标是确定有尿路感染（即细菌尿和脓尿）实验室证据的养老院居民子集，其中抗生素治疗可减少不良后果（即菌血症、功能下降、死亡）。这项拟议研究的具体目的是确定与尿路感染的实验室证据相关的临床特征（尿培养中细菌尿[10万菌落形成单位]和脓尿[10万菌落形成单位]）。我们的先验假设是，特定的临床特征（即精神状态的改变、发烧、排尿模式的改变）将与尿路感染的实验室证据有关。这项观察性队列研究将在纽黑文地区的五所养老院进行，样本量估计为493名居民。65岁或以上的患者在入组时将进行基线评估，当怀疑患有尿路感染时将进行重复评估。逻辑回归模型将用于确定临床特征和尿路感染实验室证据之间的双变量和多变量关联。根据最后的多变量logistic回归模型计算出ROC曲线。这些与尿路感染的实验室证据独立相关的临床特征将与细菌尿和脓尿相结合，以创建一个基于证据的尿路感染定义。在养老院居民中识别临床相关的尿路感染是一个常见的难题，具有重要的功能、经济和感染控制意义。本研究将建立一个基于证据的尿路感染定义。未来的研究将确定抗生素治疗改善临床结果的尿路感染居民。