Clinical Features in Nursing Home Residents with Suspected UTI

描述（由申请人提供）：尿路感染（UTI）是养老院居民处方抗生素的最常见适应症。到目前为止，标准的监测，诊断和治疗的UTI在疗养院居民已取得共识，而不是经验数据。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，即决定非特异性临床变化（例如，发热、精神状态改变）是否归因于UTI以及治疗是否有益于临床结局。确定谁应该接受抗生素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。这一系列调查的长期目标是确定具有UTI实验室证据的养老院居民的子集（即，菌尿加脓尿），其中抗生素治疗减少了不良结果（即，菌血症、功能衰退、死亡）。这项拟议研究的具体目的是确定与UTI实验室证据相关的临床特征（菌尿[尿培养> 100，000个菌落形成单位]加脓尿[尿分析>10个白色血细胞]）。我们的先验假设是，特定的临床特征（即，精神状态改变、发热、排尿方式改变）将与UTI的实验室证据相关。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岁或以上的患者将在入组时接受基线评估，并在怀疑患有UTI时进行重复评估。将使用逻辑回归模型来确定UTI临床特征和实验室证据之间的双变量和多变量关联。将根据最终多变量逻辑回归模型计算ROC曲线。与UTI实验室证据独立相关的临床特征将与菌尿和脓尿结合，以创建UTI的循证定义。确定临床相关的尿路感染在疗养院居民是一个共同的困境，具有重要的功能，经济和感染控制的影响。这项研究将创建一个基于证据的UTI定义。未来的研究将确定抗生素治疗可改善临床结局的UTI患者。

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.