Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly

Pescatore, Richard; Niforatos, Joshua D.; Rezaie, Salim R.; Swaminathan, Anand

doi:10.5811/westjem.2019.5.42096

Cited by 7 publications

(11 citation statements)

References 39 publications

(37 reference statements)

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“…Urine culture had a high rate of contamination, which often led to repetitive urine culture. Contamination rates were significantly higher in cultures of midstream voided urine than in catheterized urine, in accord with a previous report [38]. This finding may also be related to patient age because 52% of these cases were aged over 60 years.…”

Section: Discussionsupporting

confidence: 90%

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Clinical Utilization of Blood and Urine Cultures and Incidences of Bacteremia and Bacteriuria in a Hospital in Thailand

Lekskulchai

2020

Med Sci Monit Basic Res

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Background: To effectively treat sepsis and urinary tract infection (UTI), blood and urine cultures should be used appropriately and relative to incidences of bacteremia and bacteriuria. This study aimed to investigate the use of blood and urine cultures and incidences of bacteremia and bacteriuria in a hospital in Thailand. Material/Methods: Medical records of patients admitted from 2016 to 2018 were randomly selected and data in the records were anonymously extracted for investigation. Results: From 12 000 records, data on blood and urine cultures were extracted from 9% and 4% of them, respectively. The negative rate of blood culture was 87.48%. Bacteremia was detected in 10.22%. The positive rate of urine culture was 27.38% and the contamination rate was 31.26%. Escherichia coli was the most common cause of community-onset bacteremia and bacteriuria. Methicillin-resistant coagulase-negative staphylococci and Acinetobacter baumannii were the most common cause of hospital-acquired bacteremia while yeasts were the most common cause of hospital-acquired UTI. Conclusions: A high negative rate of blood culture may result not only from its low sensitivity but also from liberal test use to identify sepsis in some conditions. Improper urine collection is the main problem with use of urine culture.

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Section: Discussionsupporting

confidence: 90%

“…This finding may also be related to patient age because 52% of these cases were aged over 60 years. Most elderly patients have physical impairments that cause inherent difficulty in self-urine collection, therefore, more invasive collection methods are required to establish a reliable diagnosis [ 20 , 38 – 40 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Utilization of Blood and Urine Cultures and Incidences of Bacteremia and Bacteriuria in a Hospital in Thailand

Lekskulchai

2020

Med Sci Monit Basic Res

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“…Prior studies have suggested that the APACHE II score could be used to effectively assess the severity of patients’ critical conditions and predict the mortality of severe patients admitted to intensive care units. [ 14 , 15 ] Moreover, the maximum theoretical score of APACHE II would be up to 71. The higher the score, the more serious the illness.…”

Section: Discussionmentioning

confidence: 99%

“…Urosepsis is the most common serious complication of urinary tract infection and is clinically characterized by occult onset, rapid progression, and poor prognosis. [ 1 , 2 ] If some patients suffering from it cannot be diagnosed as early as possible, their conditions would deteriorate rapidly, resulting in an increase in clinical mortality. [ 3 ] Urosepsis develops in 3 stages: systemic inflammatory response syndrome, sepsis, and septic shock each of which has a rate of clinical mortality that is apparently different from the others.…”

Section: Introductionmentioning

confidence: 99%

Prognostic values of procalcitonin and platelet in the patient with urosepsis

2021

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Background: The patient suffering from urinary sepsis is often accompanied by elevated serum procalcitonin (PCT) levels and a decline in the average platelet count (PLT), which could result in a poor prognosis. This study aimed to evaluate the value of PCT and PLT in determining the severity of urinary sepsis. Methods: A total of 120 urosepsis patients enrolled were divided into a survival group and a death group, respectively, according to their status within 14 days after admission. Changes in PCT and PLT levels between the 2 groups were compared at different time points. A receiver operating characteristic (ROC) curve was eventually obtained to predict the prognostic value of PCT and PLT. Results: The PCT levels in the survival group declined gradually after admission, and the PLT decreased at first but increased rapidly in subsequence. The PCT level in the death group, however, declined in a flat-slope trend or was hardly noticeable together with the number of PLT reduced significantly. In particular, it is on the 3rd day that PCT tended to positively correlate with acute physiological and chronic health score II (APACHE II) score ( r = 0.730, P < .05), but negatively with PLT ( r = 0.472, P < .05). The APACHE II score and PLT ( r = 0.612, P < .05) were also negatively correlated with each other. As indicated by the ROC curve, the PCT level on the 3rd day after admission was of great value for the clinical mortality prognosis, and the area under the curve was 0.858. Moreover, PLT also has a high predictive value for prognosis. Area under the curve is 0.951. When the PLT was more than 51 × 10 9 /L, the sensitivity was up to 90%, and the specificity was 90%. Conclusion: PLT and PCT levels are closely related to the APACHE II score, which could indicate the severity of urosepsis in patients. The contribution of this study was to confirm that dynamic monitoring of the changes in PCT and PLT helps determine the prognosis of urosepsis patients.

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“…The use of PCT in the work-up of UTI has become of increasing interest to emergency medicine providers [ 20 , 45 ]. While PCT levels do correlate with bacteremia, C—reactive protein does not show any correlation with relevant clinical parameters in patients with febrile UTI [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

A diagnostic algorithm for detection of urinary tract infections in hospitalized patients with bacteriuria: The “Triple F” approach supported by Procalcitonin and paired blood and urine cultures

et al. 2020

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For acute medicine physicians, distinguishing between asymptomatic bacteriuria (ABU) and clinically relevant urinary tract infections (UTI) is challenging, resulting in overtreatment of ABU and under-recognition of urinary-source bacteraemia without genitourinary symptoms (USB). We conducted a retrospective analysis of ED encounters in a university hospital between October 2013 and September 2018 who met the following inclusion criteria: Suspected UTI with simultaneous collection of paired urinary cultures and blood cultures (PUB) and determination of Procalcitonin (PCT). We sought to develop a simple algorithm based on clinical signs and PCT for the management of suspected UTI. Individual patient presentations were retrospectively evaluated by a clinical “triple F” algorithm (F1 =“ f ever”, F2 =“ f ailure”, F3 =“ f ocus”) supported by PCT and PUB. We identified 183 ED patients meeting the inclusion criteria. We introduced the term UTI with systemic involvement (SUTI) with three degrees of diagnostic certainty: bacteremic UTI (24.0%; 44/183), probable SUTI (14.2%; 26/183) and possible SUTI (27.9%; 51/183). In bacteremic UTI, half of patients (54.5%; 24/44) presented without genitourinary symptoms. Discordant bacteraemia was diagnosed in 16 patients (24.6% of all bacteremic patients). An alternative focus was identified in 67 patients, five patients presented with S . aureus bacteremia. 62 patients were diagnosed with possible UTI (n = 20) or ABU (n = 42). Using the proposed “triple F” algorithm, dichotomised PCT of < 0.25 pg/ml had a negative predictive value of 88.7% and 96.2% for bacteraemia und accordant bacteraemia respectively. The application of the algorithm to our cohort could have resulted in 33.3% reduction of BCs. Using the diagnostic categories “possible” or “probable” SUTI as a trigger for initiation of antimicrobial treatment would have reduced or streamlined antimicrobial use in 30.6% and 58.5% of cases, respectively. In conclusion, the “3F” algorithm supported by PCT and PUB is a promising diagnostic and antimicrobial stewardship tool.

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Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly

Cited by 7 publications

References 39 publications

Clinical Utilization of Blood and Urine Cultures and Incidences of Bacteremia and Bacteriuria in a Hospital in Thailand

Clinical Utilization of Blood and Urine Cultures and Incidences of Bacteremia and Bacteriuria in a Hospital in Thailand

Prognostic values of procalcitonin and platelet in the patient with urosepsis

A diagnostic algorithm for detection of urinary tract infections in hospitalized patients with bacteriuria: The “Triple F” approach supported by Procalcitonin and paired blood and urine cultures

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