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Validity of Rapid Tests to Detect Nosocomial Urinary Tract Infection in Hospital*

医院内尿路感染快速检测的有效性*

基本信息

批准号：
7900572
负责人：
THOMAS J BLODGETT
金额：
$ 2.63万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-01 至 2012-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7900572
关键词：
Acute Adult Affect Antibiotic Resistance Area Aspirate substance Bacteria Bedside Testings Bladder neck obstruction Catheters Cells Centers for Disease Control and Prevention (U.S.)Cessation of life Chronic Disease Clinical Cross-Sectional Studies Delirium Detection Devices Diagnosis Diagnostic Diagnostic Procedure Early treatment Economics Elderly Event Face Gold Hospitals Hour Hydronephrosis Immune Immune response Indwelling Catheter Infection Inflammatory Injury Intervention Leukocytes Link Measures Medicare/Medicaid Microbe Nitrates Nitrites Nosocomial Infections Older Population Organism Outcome Patient Care Patients Policies Population Predictive Value Pyelonephritis Reporting Reproduction Research Research Personnel Sensitivity and Specificity Septic Shock Testing Time Urethra Urinalysis Urinary tract infection Urine Uropathogen catheter associated UTI efficacy testing health care service organization immunosenescence leukocyte esterase milliliter nosocomial UTI novel pathogen patient population point of care prevent psychologic response urinary

项目摘要

DESCRIPTION (provided by applicant): The purpose of this study is to examine the diagnostic validity of the leukocyte esterase and nitrite tests in the point-of-care detection of catheter-associated urinary tract infection in hospitalized older adults. It is estimated that 40% of all hospitalized patients will acquire some type of nosocomial infection, and catheter-associated urinary tract infection (CAUTI) is the most common. According to a recent report by the Centers for Disease Control and Prevention, approximately 32% of acute care patients will develop a CAUTI. Besides limiting the use of urinary catheters, there is currently very little evidence to support preventitive interventions for this condition in the hospitalized older adult population. Before novel interventions can be tested for efficacy, researchers must first understand the diagnostic validity of available CAUTI measures, including the rapid, inexpensive, and commonly utilized leukocyte esterase and nitrite tests. Research indicates that older adults, particularly those with chronic diseases, may be unable to mount an effective immune response against pathogens. This phenomenon, termed "immunosenescence," has the potential to restrict the white blood cell response to urinary pathogens, reflected by a "negative" leukocyte esterase test. Alternatively, an active, acute infection elsewhere in the body, which is likely in the hospital setting, may elevate the white blood cell response, leading to a "positive" leukocyte esterase test in the hospitalized older adult population. It is not known what "net effect" these two phenomena have on the overall diagnostic validity of the leukocyte esterase test in this population, but the proposed study will inform this area of inquiry. Furthermore, research indicates that a reduced concentration of urinary bacteria in the quantitative urine culture, the diagnostic "gold standard" for UTI, should be used in patients with urinary catheters. This reduced concentration of 1,000 (rather than 100,000) organisms per milliliter of urine will be the "gold standard" against which the leukocyte esterase and nitrite tests will be compared in the proposed study. The three aims for this cross-sectional study are to: 1) Determine the sensitivity, specificity, and positive predictive value of the leukocyte esterase test to detect CAUTI in hospitalized older adults; 2) Determine the sensitivity, specificity, and positive predictive value of the nitrite test to detect CAUTI in hospitalized older adults, and; 3) Examine the diagnostic validity of the combined leukocyte esterase and nitrite tests to detect CAUTI in hospitalized older adults. This research has the potential to eliminate the delay in CAUTI identification and treatment in hospitalized elders, which may prevent the complications associated with high bacterial-load CAUTI, such as pyelonephritis, septic shock, and death.

描述（由申请人提供）：本研究的目的是检查白细胞酯酶和亚硝酸盐测试在住院老年人导管相关尿路感染的即时检测中的诊断有效性。据估计，所有住院患者中有 40% 会发生某种类型的院内感染，其中导管相关尿路感染 (CAUTI) 是最常见的。根据疾病控制与预防中心最近的一份报告，大约 32% 的急症患者会出现 CAUTI。除了限制导尿管的使用外，目前几乎没有证据支持对住院老年人群中的这种情况进行预防性干预。在测试新干预措施的功效之前，研究人员必须首先了解现有 CAUTI 措施的诊断有效性，包括快速、廉价且常用的白细胞酯酶和亚硝酸盐测试。研究表明，老年人，尤其是患有慢性疾病的老年人，可能无法对病原体产生有效的免疫反应。这种现象被称为“免疫衰老”，有可能限制白细胞对泌尿病原体的反应，这可以通过白细胞酯酶测试“阴性”反映出来。或者，身体其他部位的活跃急性感染（可能发生在医院环境中）可能会增强白细胞反应，导致住院老年人群中白细胞酯酶测试呈“阳性”。目前尚不清楚这两种现象对该人群中白细胞酯酶测试的整体诊断有效性有何“净影响”，但拟议的研究将为这一领域的研究提供信息。此外，研究表明，尿路感染的诊断“金标准”——定量尿培养中尿液细菌浓度的降低应该用于导尿管患者。每毫升尿液中 1,000 个（而不是 100,000 个）生物体的浓度降低将成为拟议研究中比较白细胞酯酶和亚硝酸盐测试的“黄金标准”。这项横断面研究的三个目标是： 1) 确定白细胞酯酶试验检测住院老年人 CAUTI 的敏感性、特异性和阳性预测值； 2) 确定亚硝酸盐测试检测住院老年人 CAUTI 的敏感性、特异性和阳性预测值； 3) 检查联合白细胞酯酶和亚硝酸盐测试检测住院老年人 CAUTI 的诊断有效性。这项研究有可能消除住院老年人 CAUTI 识别和治疗的延迟，从而可以预防与高细菌载量 CAUTI 相关的并发症，如肾盂肾炎、感染性休克和死亡。