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Lui S, Carr F, Gibson W. Diagnosis of urinary tract infections in the hospitalized older adult population in Alberta. PLoS One 2024; 19:e0300564. [PMID: 38848404 PMCID: PMC11161040 DOI: 10.1371/journal.pone.0300564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common infections reported in older adults, across all settings. Although a diagnosis of a UTI requires specific clinical and microbiological criteria, many older adults are diagnosed with a UTI without meeting the diagnostic criteria, resulting in unnecessary antibiotic treatment and their potential side effects, and a failure to find the true cause of their presentation to hospital. OBJECTIVE The aim of this study was to evaluate the accuracy of UTI diagnoses amongst hospitalized older adults based on clinical and microbiological findings, and their corresponding antibiotic treatment (including complications), in addition to identifying possible factors associated with a confirmed UTI diagnosis. METHODS A single-center retrospective cross-sectional study of older adult patients (n = 238) hospitalized at the University of Alberta Hospital with an admission diagnosis of UTI over a one-year period was performed. RESULTS 44.6% (n = 106) of patients had a diagnosis of UTI which was supported by documents clinical and microbiological findings while 43.3% (n = 103) of patients had bacteriuria without documented symptoms. 54.2% (n = 129) of all patients were treated with antibiotics, despite not having evidence to support a diagnosis of a UTI, with 15.9% (n = 37) of those patients experiencing complications including diarrhea, Clostridioides difficile infection, and thrush. History of major neurocognitive disorder was significantly associated with diagnosis of UTI (p = 0.003). CONCLUSION UTIs are commonly misdiagnosed in hospitalized older adults by healthcare providers, resulting in the majority of such patients receiving unnecessary antibiotics, increasing the risk of complications. These findings will allow for initiatives to educate clinicians on the importance of UTI diagnosis in an older adult population and appropriately prescribing antibiotics to prevent unwanted complications.
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Affiliation(s)
- Samantha Lui
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Frances Carr
- Division of Geriatric Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - William Gibson
- Division of Geriatric Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Bijlani N, Nilforooshan R, Kouchaki S. An Unsupervised Data-Driven Anomaly Detection Approach for Adverse Health Conditions in People Living With Dementia: Cohort Study. JMIR Aging 2022; 5:e38211. [PMID: 36121687 PMCID: PMC9531007 DOI: 10.2196/38211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/04/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sensor-based remote health monitoring can be used for the timely detection of health deterioration in people living with dementia with minimal impact on their day-to-day living. Anomaly detection approaches have been widely applied in various domains, including remote health monitoring. However, current approaches are challenged by noisy, multivariate data and low generalizability. OBJECTIVE This study aims to develop an online, lightweight unsupervised learning-based approach to detect anomalies representing adverse health conditions using activity changes in people living with dementia. We demonstrated its effectiveness over state-of-the-art methods on a real-world data set of 9363 days collected from 15 participant households by the UK Dementia Research Institute between August 2019 and July 2021. Our approach was applied to household movement data to detect urinary tract infections (UTIs) and hospitalizations. METHODS We propose and evaluate a solution based on Contextual Matrix Profile (CMP), an exact, ultrafast distance-based anomaly detection algorithm. Using daily aggregated household movement data collected via passive infrared sensors, we generated CMPs for location-wise sensor counts, duration, and change in hourly movement patterns for each patient. We computed a normalized anomaly score in 2 ways: by combining univariate CMPs and by developing a multidimensional CMP. The performance of our method was evaluated relative to Angle-Based Outlier Detection, Copula-Based Outlier Detection, and Lightweight Online Detector of Anomalies. We used the multidimensional CMP to discover and present the important features associated with adverse health conditions in people living with dementia. RESULTS The multidimensional CMP yielded, on average, 84.3% recall with 32.1 alerts, or a 5.1% alert rate, offering the best balance of recall and relative precision compared with Copula-Based and Angle-Based Outlier Detection and Lightweight Online Detector of Anomalies when evaluated for UTI and hospitalization. Midnight to 6 AM bathroom activity was shown to be the most important cross-patient digital biomarker of anomalies indicative of UTI, contributing approximately 30% to the anomaly score. We also demonstrated how CMP-based anomaly scoring can be used for a cross-patient view of anomaly patterns. CONCLUSIONS To the best of our knowledge, this is the first real-world study to adapt the CMP to continuous anomaly detection in a health care scenario. The CMP inherits the speed, accuracy, and simplicity of the Matrix Profile, providing configurability, the ability to denoise and detect patterns, and explainability to clinical practitioners. We addressed the need for anomaly scoring in multivariate time series health care data by developing the multidimensional CMP. With high sensitivity, a low alert rate, better overall performance than state-of-the-art methods, and the ability to discover digital biomarkers of anomalies, the CMP is a clinically meaningful unsupervised anomaly detection technique extensible to multimodal data for dementia and other health care scenarios.
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Affiliation(s)
- Nivedita Bijlani
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Ramin Nilforooshan
- Surrey and Borders Partnership NHS Foundation Trust, Guildford, United Kingdom
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College, London, United Kingdom
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Samaneh Kouchaki
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College, London, United Kingdom
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Presumed Urinary Tract Infection in Patients Admitted with COVID-19: Are We Treating Too Much? Antibiotics (Basel) 2021; 10:antibiotics10121493. [PMID: 34943705 PMCID: PMC8698875 DOI: 10.3390/antibiotics10121493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023] Open
Abstract
Despite the low rates of bacterial co-/superinfections in COVID-19 patients, antimicrobial drug use has been liberal since the start of the COVID-19 pandemic. Due to the low specificity of markers of bacterial co-/superinfection in the COVID-19 setting, overdiagnosis and antimicrobial overprescription have become widespread. A quantitative and qualitative evaluation of urinary tract infection (UTI) diagnoses and antimicrobial drug prescriptions for UTI diagnoses was performed in patients admitted to the COVID-19 ward of a university hospital between 17 March and 2 November 2020. A team of infectious disease specialists performed an appropriateness evaluation for every diagnosis of UTI and every antimicrobial drug prescription covering a UTI. A driver analysis was performed to identify factors increasing the odds of UTI (over)diagnosis. A total of 622 patients were included. UTI was present in 13% of included admissions, and in 12%, antimicrobials were initiated for a UTI diagnosis (0.71 daily defined doses (DDDs)/admission; 22% were scored as ‘appropriate’). An evaluation of UTI diagnoses by ID specialists revealed that of the 79 UTI diagnoses, 61% were classified as probable overdiagnosis related to the COVID-19 hospitalization. The following factors were associated with UTI overdiagnosis: physicians who are unfamiliar working in an internal medicine ward, urinary incontinence, mechanical ventilation and female sex. Antimicrobial stewardship teams should focus on diagnostic stewardship of UTIs, as UTI overdiagnosis seems to be highly prevalent in admitted COVID-19 patients.
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Recommendations of the AFU Infectious Diseases Committee on the prevention, diagnosis and treatment of infections of endo-ureteral equipment. Prog Urol 2021; 31:557-575. [PMID: 34154957 DOI: 10.1016/j.purol.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/06/2020] [Accepted: 02/11/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION No recent national guidelines exist regarding the management of urinary tract infections (UTIs) in the presence of ureteral stent. This situation could lead to discrepancies in clinical management and less opportunity for a favorable patient's outcome. METHODS All available data published on Medline® between 1998 and 2018 were systematically searched and reviewed. All papers assessing adult patients carrying ureteral stent were included for analysis. After studies critical analysis, national guidelines for clinical management were elaborated in order to answer clinical questions. RESULTS A total of 451 articles were identified, of which 58 have been included. The prevalence of urinary tract infections in the presence of ureteral stent remains unknown. After 3 months, all endo-ureteral devices were colonized on microbiological study. These patients also presented a positive urine culture in 25 to 70% of the cases, often polymicrobial. Staphylococci, E. coli, Klebsiella, Pseudomonas, Enterococcus and Candida were the commonest micro-organisms responsible for urinary colonization or infection. The risk of UTI on endo-ureteral devices seemed higher the longer it stayed implanted. There is no justification in the literature to recommend a systematic change of endo-ureteral devices following a urinary tract infection. DISCUSSION The existing literature is rich but of poor methodological quality, and therefore does not allow to draw robust conclusions. The greatest difficulty faced in this work was to accurately differentiate urinary colonizations from true infections, including clinical symptoms and not only microbiological results. CONCLUSION These guidelines propose a standardized management of such common clinical situations. Well-designed studies are needed to upgrade the level of evidence of these guidelines.
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Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact. Diagnostics (Basel) 2021; 11:diagnostics11030523. [PMID: 33804271 PMCID: PMC8001488 DOI: 10.3390/diagnostics11030523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
In older patients, urinary tract infection (UTI) often has an atypical clinical presentation, making its diagnosis difficult. We aimed to describe the clinical presentation in older inpatients with UTI-related bacteremia and to determine the prognostic impact of atypical presentation. This cohort study included all consecutive patients older than 75 years hospitalized in a university hospital in 2019 with a UTI-related gram-negative bacillus (GNB) bacteremia, defined by blood and urine cultures positive for the same GNB, and followed up for 90 days. Patients with typical symptoms of UTI were compared to patients with atypical forms. Among 3865 inpatients over 75 with GNB-positive urine culture over the inclusion period, 105 patients (2.7%) with bacteremic UTI were included (mean age 85.3 ± 5.9, 61.9% female). Among them, UTI symptoms were reported in only 38 patients (36.2%) and 44 patients (41.9%) had no fever on initial management. Initial diagnosis of UTI was made in only 58% of patient. Mortality at 90 days was 23.6%. After adjustment for confounders, hyperthermia (HR = 0.37; IC95 (0.14–0.97)) and early UTI diagnosis (HR = 0.35; IC95 (0.13–0.94)) were associated with lower mortality, while UTI symptoms were not associated with prognosis. In conclusion, only one third of older patients with UTI developing bacteremia had UTI symptoms. However, early UTI diagnosis was associated with better survival.
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Godaert L, Cofais C, Hequet F, Proye E, Kanagaratnam L, Césaire R, Najioullah F, Dramé M. Adaptation of WHO Definitions of Clinical Forms of Chikungunya Virus Infection for the Elderly. Am J Trop Med Hyg 2021; 104:106-109. [PMID: 33258441 DOI: 10.4269/ajtmh.20-0761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The WHO defined three clinical forms for chikungunya virus infection (CHIKV, namely, acute, atypical, and severe cases) and a chronic form. These definitions seemed inappropriate for the elderly. So, we propose an adapted definition for elderly people. A cross-sectional analysis was performed including patients aged ≥ 65 years, who attended the emergency department with a positive biological diagnosis of CHIKV in 2014. A total of 267 elderly patients (80 ± 8 years) were included. When using the 2015 WHO definitions, 114 patients could not be classified (42.7%) in any of the category, of whom 43 (37.7%) reported absence of fever, 85 (74.6%) reported absence of joint pain, and 14 (12.3%) reported absence of both fever and joint pain. After adaptation of the WHO definitions, the 114 unclassifiable patients were reclassified as follows: eight as typical cases, 50 as atypical cases, 42 as severe cases, and 14 remained unclassifiable. The atypical clinical form was the most common form. The 2015 WHO definitions of the clinical forms at the acute phase of CHIKV are ill suited to the elderly. The adapted definition we propose here appears to be more appropriate and could help improved management of older patients with CHIKV.
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Affiliation(s)
- Lidvine Godaert
- 1Department of Geriatrics, Valenciennes General Hospital, Valenciennes, France
| | - Cécilia Cofais
- 2Department of Geriatrics, University Hospitals of Rennes, Rennes, France
| | - Fanny Hequet
- 1Department of Geriatrics, Valenciennes General Hospital, Valenciennes, France
| | - Emeline Proye
- 1Department of Geriatrics, Valenciennes General Hospital, Valenciennes, France
| | - Lukshe Kanagaratnam
- 3Department of Research and Public Health, University Hospitals of Reims, Reims, France
| | - Raymond Césaire
- 4Department of Virology, University Hospitals of Martinique, Fort-de-France, Martinique
| | - Fatiha Najioullah
- 4Department of Virology, University Hospitals of Martinique, Fort-de-France, Martinique
| | - Moustapha Dramé
- 5Department of Clinical Research and Innovation, University Hospitals of Martinique, Fort-de-France, Martinique
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Kosheleva L, Ngune I. Registered Nurses' Decisions Around Referral of Residents With Urinary Tract Infections: A Retrospective Cohort Study. J Prim Care Community Health 2020; 11:2150132720957441. [PMID: 32924763 PMCID: PMC7493263 DOI: 10.1177/2150132720957441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Referral of residents with urinary tract infections (UTIs) in residential aged care facilities (RACFs) to hospital are common. However, there is limited information on what influences Registered Nurses’ (RN) decision-making process. Aim To investigate resident factors that influence RN’s decisions to escalate care. Design A retrospective cohort approach audited electronic clinical records of residents with UTIs. Methods Data were extracted from the electronic database and analyzed using descriptive and regression analysis. Approval was obtained from both the RACFs and University Human Research Ethics Committee. Results There was a higher likelihood of being referred to hospital if residents were female, had had a past fall, had related comorbidity, or had abnormal vital signs. However, being older and having a urinary catheter were protective factors for referral by the RN. Conclusion Referral of residents with UTIs by RNs to hospital is common in RACFs. Resident characteristics such as abnormal vital signs, past falls, and presence of comorbidity influence referrals by RNs. Nurse Practitioners dedicated to the RACFs could complement the role of a general practitioner. UTI-specific escalation protocols can assist RNs to make decisions about referrals. RNs’ related risk factors also need to be examined to understand other influencing factors.
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Affiliation(s)
- Ludmila Kosheleva
- Curtin University, Perth, Western Australia, Australia.,Bethanie Aged Care Facilities, Perth, Western Australia
| | - Irene Ngune
- Curtin University, Perth, Western Australia, Australia
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Coudert M, Pépin M, de Thezy A, Fercot E, Laycuras M, Coudert AL, Duran C, Bouchand F, Davido B, Le Crane M, Denis B, Muller F, Gourdon M, Peng CL, Mahamdia R, Mekerta Z, Seridi Z, Gaillard JL, Leichowski L, Moulias S, Rottman M, Sivadon-Tardy V, Teillet L, Dinh A. Présentation clinique et performance de la bandelette urinaire pour le diagnostic d’infection urinaire en population gériatrique. Rev Med Interne 2019; 40:714-721. [DOI: 10.1016/j.revmed.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
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Amarsy R, Guéret D, Benmansour H, Flicoteaux R, Berçot B, Meunier F, Mougari F, Jacquier H, Pean de Ponfilly G, Clermont O, Denamur E, Teixeira A, Cambau E. Determination of Escherichia coli phylogroups in elderly patients with urinary tract infection or asymptomatic bacteriuria. Clin Microbiol Infect 2019; 25:839-844. [PMID: 30648603 DOI: 10.1016/j.cmi.2018.12.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Distinguishing between urinary tract infection (UTI) and asymptomatic bacteriuria (ABU) is difficult in the geriatric population since specific symptoms are often lacking. Escherichia coli is the most frequent UTI pathogen in this population but also a common urine colonizer. We hypothesized that detecting E. coli phylogroups B2 or D, which were previously associated with virulent strains responsible for extra-intestinal infections outside elderly patients, could help in distinguishing UTI from ABU. METHODS Consecutive cases of E. coli bacteriuria diagnosed in hospitalized patients >75 years old during 3 months were investigated for E. coli phylogroups. Multiplex PCR was used to search for several virulence genes as previously described. Characteristics of UTI and ABU cases, assessed retrospectively according to definitions and geriatric expertise, were compared. RESULTS Out of 233 bacteriuria cases, 60 were assessed to be UTI and 163 to be ABU, with 10 cases unclassified. E. coli strains belonging to the phylogroups B2 and D were significantly more frequent in UTI (48/60, 80%) than in ABU (101/163, 62%) by univariate and multivariate analyses (OR 3.05, 1.44-6.86, p 0.005). Out of all the host and bacterial characteristics studied, falls (p 0.032), comorbidities (p 0.041), and altered autonomy evaluated by a low activity of daily living score (p 0.027) were also associated with UTI using univariate and multivariate analysis. CONCLUSIONS Determination of the E. coli phylogroup, in addition to some host characteristics, can help to distinguish UTI from ABU in elderly patients with bacteriuria. If this hypothesis is confirmed by prospective studies, then inappropriate use of antibiotics may be reduced in ABU cases.
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Affiliation(s)
- R Amarsy
- APHP, Groupe Hospitalier Lariboisière-Fernand Widal, Equipe Opérationnelle d'Hygiène, Paris, France; Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - D Guéret
- Service de SSR Gériatrique, Centre Hospitalier de la Côte Fleurie, Equemauville, France
| | - H Benmansour
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - R Flicoteaux
- Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, France; ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Centre (CRESS), Paris, France
| | - B Berçot
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - F Meunier
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - F Mougari
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - H Jacquier
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - G Pean de Ponfilly
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - O Clermont
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - E Denamur
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - A Teixeira
- Service de Gériatrie, Hôpitaux Universitaires Saint Louis Lariboisière Fernand, Paris, France
| | - E Cambau
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France.
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van Buul LW, Vreeken HL, Bradley SF, Crnich CJ, Drinka PJ, Geerlings SE, Jump RLP, Mody L, Mylotte JJ, Loeb M, Nace DA, Nicolle LE, Sloane PD, Stuart RL, Sundvall PD, Ulleryd P, Veenhuizen RB, Hertogh CMPM. The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure. J Am Med Dir Assoc 2018; 19:757-764. [PMID: 29910137 DOI: 10.1016/j.jamda.2018.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/11/2018] [Accepted: 05/01/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Nonspecific signs and symptoms combined with positive urinalysis results frequently trigger antibiotic therapy in frail older adults. However, there is limited evidence about which signs and symptoms indicate urinary tract infection (UTI) in this population. We aimed to find consensus among an international expert panel on which signs and symptoms, commonly attributed to UTI, should and should not lead to antibiotic prescribing in frail older adults, and to integrate these findings into a decision tool for the empiric treatment of suspected UTI in this population. DESIGN A Delphi consensus procedure. SETTING AND PARTICIPANTS An international panel of practitioners recognized as experts in the field of UTI in frail older patients. MEASURES In 4 questionnaire rounds, the panel (1) evaluated the likelihood that individual signs and symptoms are caused by UTI, (2) indicated whether they would prescribe antibiotics empirically for combinations of signs and symptoms, and (3) provided feedback on a draft decision tool. RESULTS Experts agreed that the majority of nonspecific signs and symptoms should be evaluated for other causes instead of being attributed to UTI and that urinalysis should not influence treatment decisions unless both nitrite and leukocyte esterase are negative. These and other findings were incorporated into a decision tool for the empiric treatment for suspected UTI in frail older adults with and without an indwelling urinary catheter. CONCLUSIONS A decision tool for suspected UTI in frail older adults was developed based on consensus among an international expert panel. Studies are needed to evaluate whether this decision tool is effective in reaching its aim: the improvement of diagnostic evaluation and treatment for suspected UTI in frail older adults.
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Affiliation(s)
- Laura W van Buul
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Hilde L Vreeken
- Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
| | - Suzanne F Bradley
- Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System and the University of Michigan Medical School, Ann Arbor, MI
| | - Christopher J Crnich
- University of Wisconsin School of Medicine and Public Health, Madison, WI; Medical Service, William S. Middleton VA Hospital, Madison, WI
| | - Paul J Drinka
- Department of Internal Medicine, Geriatrics University of Wisconsin, Madison, WI
| | - Suzanne E Geerlings
- Division Infectious Diseases, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Robin L P Jump
- Geriatric Research, Education and Clinical Center and Specialty Care Center of Innovation at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Epidemiology and Biostatistics at Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lona Mody
- University of Michigan and Geriatrics Research Education and Clinical Care, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Joseph J Mylotte
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Mark Loeb
- Department of Pathology and Molecular Medicine and Institute for Infectious Diseases Research, McMaster University, Hamilton, Canada
| | - David A Nace
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Philip D Sloane
- Department of Family Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rhonda L Stuart
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia; Monash University, Victoria, Australia; National Centre for Antimicrobial Stewardship, Victoria, Australia
| | - Pär-Daniel Sundvall
- Närhälsan, Research and Development Primary Health Care Region Västra Götaland, R&D Center Södra Älvsborg, Sweden; The Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Peter Ulleryd
- Department of Communicable Disease Control, Region Västra Götaland, Sweden
| | - Ruth B Veenhuizen
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Shigemura K, Kitagawa K, Osawa K, Yamamichi F, Tokimatsu I, Nomi M, Takaba K, Fujisawa M. Comparison of antibiotics use, urinary tract infection (UTI)-causative bacteria and their antibiotic susceptibilities among 4 hospitals with different backgrounds and regions in Japan. J Chemother 2017; 30:31-36. [PMID: 28956738 DOI: 10.1080/1120009x.2017.1376817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, we compared the antibiotic use, urinary tract infection-causative bacteria and their antibiotic susceptibilities among four hospitals with different backgrounds and regions in Japan in 2014. Frequency of antibiotic use (antibiotic use density: AUD/all AUD) were: ampicillin: 0.21-20.3 (median: 1.6) and cefazolin: 0.8-34.2 (2.5), representatively. The antibiotic resistant rates of Escherichia coli were ampicillin: 1.1-52.3% (median: 51.8%), piperacillin: 47.9-49.1% (48.0%), cefazolin: 23.2-34.1% (28.9%), levofloxacin: 36.6-43.8% (40.2%).We found that there were significant correlations (1) between antibiotic resistance of E. coli and annual total amount of antibiotic use (p = 0.017), annual number of days of antibiotic use (p = 0.002) and days of therapy (DOT, p = 0.002), and (2) between antibiotic resistance of extended-spectrum β-lactamase-producing bacteria and annual number of days of antibiotic use (p = 0.004) and DOT (p = 0.004) in a rehabilitation hospital. These results suggested that more antibiotic uses could lead to antibiotic resistances. Further analyses with more number of data are being undertaken.
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Affiliation(s)
- Katsumi Shigemura
- a Department of Urology , Kobe University Graduate School of Medicine , Kobe , Japan.,b Infection Control and Prevention , Kobe University Graduate School of Medicine , Kobe , Japan.,c Division of Infectious Diseases, Department of International Health Science , Kobe University Graduate School of Health Science , Kobe , Japan
| | - Koichi Kitagawa
- d Division of Translational Research for Biologics, Department of Internal Related , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kayo Osawa
- b Infection Control and Prevention , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Fukashi Yamamichi
- e Department of Urology , Hyogo Prefectural Amagasaki General Medical Center , Amagasaki , Hyogo , Japan
| | - Issei Tokimatsu
- b Infection Control and Prevention , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Masashi Nomi
- f Infection control and prevention , Hyogo Prefectural Rehabilitation Central Hospital , Kobe , Japan
| | - Kei Takaba
- g Infection control and prevention , Mie Prefectural General Medical Center , Mie , Japan
| | - Masato Fujisawa
- a Department of Urology , Kobe University Graduate School of Medicine , Kobe , Japan
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12
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Sousa ÁFLD, Queiroz AAFLN, Oliveira LBD, Moura LKB, Andrade DD, Watanabe E, Moura MEB. Deaths among the elderly with ICU infections. Rev Bras Enferm 2017; 70:733-739. [PMID: 28793102 DOI: 10.1590/0034-7167-2016-0611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/22/2017] [Indexed: 11/22/2022] Open
Abstract
Objective to evaluate the clinical outcome of elderly patients admitted to intensive care units who had nosocomial infection, correlating the findings with sociodemographic and clinical variables. Method descriptive research, performed with 308 elderly patients. The collection was made from medical records and covers the years 2012 to 2015. Uni-/bivariate analyses were performed. Results a statistical association was found between the clinical outcome types and the variables age, length of stay, presence of previous comorbidities, main diagnosis, respiratory and urinary tract infections, use of central venous and indwelling urinary catheters, mechanical ventilation, and tracheostomy. The survival curve showed higher mortality among the elderly from the age of 80 on. Conclusion the clinical outcome of the elderly who acquire infection in the intensive care unit is influenced by sociodemographic and clinical variables that increase mortality rates.
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Affiliation(s)
- Álvaro Francisco Lopes de Sousa
- Universidade de São Paulo, Nursing School of Ribeirão Preto, Postgaduate Program in Fundamental Nursing. Ribeirão Preto, São Paulo, Brazil
| | | | - Layze Braz de Oliveira
- Universidade de São Paulo, Nursing School of Ribeirão Preto, Postgaduate Program in Fundamental Nursing. Ribeirão Preto, São Paulo, Brazil
| | | | - Denise de Andrade
- Universidade de São Paulo, Nursing School of Ribeirão Preto, Postgaduate Program in Fundamental Nursing. Ribeirão Preto, São Paulo, Brazil
| | - Evandro Watanabe
- Universidade de São Paulo, Nursing School of Ribeirão Preto, Postgaduate Program in Fundamental Nursing. Ribeirão Preto, São Paulo, Brazil
| | - Maria Eliete Batista Moura
- Universidade Federal do Piauí, Health Science Center, Postgraduate Program in Nursing. Teresina, Piauí, Brazil
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13
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Nicolle LE. Asymptomatic Bacteriuria in Older Adults. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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[Urinary tract infections in the elderly]. Z Gerontol Geriatr 2015; 48:588-94. [PMID: 26318186 DOI: 10.1007/s00391-015-0947-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/13/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
Acute infection of the urinary tract is one of the most commonly encountered bacterial infections in the frail elderly population and is responsible for substantial morbidity and recurrent infections with antibiotic resistance. Although generally considered to be self-limiting without treatment or easily treated with a short antibiotic regime, urinary tract infections (UTIs) often have a dramatic history, associated with incomplete resolution and frequent recurrence. The biological complexity of the infections combined with a dramatic rise in antibiotic-resistant pathogens highlight the need for an anticipating strategy for therapy necessary for a rapid recovery. The first crucial step is the classification in asymptomatic bacteriuria or complicated pyelonephritis, on which the decision for the intensity of treatment and diagnostic effort is based. For the selection of empiric antibiotic therapy, knowledge about the predominant uropathogens as well as local resistance patterns is important. In this manner, most urinary tract infections in the elderly can be treated without greater expense.
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15
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Chang UI, Kim HW, Noh YS, Wie SH. A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis. Korean J Intern Med 2015; 30:372-83. [PMID: 25995668 PMCID: PMC4438292 DOI: 10.3904/kjim.2015.30.3.372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 11/28/2014] [Accepted: 12/02/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN. METHODS Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae. RESULTS Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level ≥ 15 mg/dL, and patients with a leukocyte count ≥ 15,000/mm(3) in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393). CONCLUSIONS Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.
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Affiliation(s)
- U-Im Chang
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-sun Noh
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Managing therapeutic competition in patients with heart failure, lower urinary tract symptoms and incontinence. Drugs Aging 2014; 31:93-101. [PMID: 24357134 PMCID: PMC3907694 DOI: 10.1007/s40266-013-0145-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Up to 50 % of heart failure patients suffer from lower urinary tract symptoms. Urinary incontinence has been associated with worse functional status in patients with heart failure, occurring three times more frequently in patients with New York Heart Association Class III and IV symptoms compared with those with milder disease. The association between heart failure and urinary symptoms may be directly attributable to worsening heart failure pathophysiology; however, medications used to treat heart failure may also indirectly provoke or exacerbate urinary symptoms. This type of drug–disease interaction, in which the treatment for heart failure precipitates incontinence, and removal of medications to relieve incontinence worsens heart failure, can be termed therapeutic competition. The mechanisms by which heart failure medication such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and β-blockers aggravate lower urinary tract symptoms are discussed. Initiation of a prescribing cascade, whereby antimuscarinic agents or β3-agonists are added to treat symptoms of urinary urgency and incontinence, is best avoided. Recommendations and practical tips are provided that outline more judicious management of heart failure patients with lower urinary tract symptoms. Compelling strategies to improve urinary outcomes include titrating diuretics, switching ACE inhibitors, treating lower urinary tract infections, appropriate fluid management, daily weighing, and uptake of pelvic floor muscle exercises.
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