scholarly journals Diagnosing urinary tract infections in febrile infants and children: when evidence-based medicine and clinical practice collide

CJEM ◽  
2000 ◽  
Vol 2 (03) ◽  
pp. 197-200 ◽  
Author(s):  
Julie Spence ◽  
John Ross
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Pediatric Patients ◽  
Therapeutic Strategies ◽  
Evidence Based ◽  
Emergency Department Management ◽  
Tract Infections ◽  
Based Medicine ◽  
Infants And Young Children

ABSTRACTThe management of febrile pediatric patients is challenging, and the literature is replete with articles describing diverse diagnostic and therapeutic strategies. As many as 5% of infants and young children presenting with fever will be diagnosed with urinary tract infection. Many controversies exist concerning the management of these infections, the most important being: how to make the diagnosis. The financial and time costs of emergency department management must be balanced against the potential future costs of investigations and complications.

Reducing Catheter-Associated Urinary Tract Infection in the Critical Care Unit

2010 ◽  
Vol 21 (3) ◽  
pp. 247-257 ◽  
Author(s):  
Mikel Gray
Keyword(s):  
Urinary Tract Infection ◽  
Critical Care ◽  
Urinary Tract ◽  
Tract Infection ◽  
Prevention Program ◽  
Critical Care Unit ◽  
Evidence Based ◽  
Indwelling Catheters ◽  
Tract Infections ◽  
Hospital Acquired

Changes in reimbursement policies have focused attention on the use of indwelling catheters in the critical care unit as well as their role in hospital-acquired urinary tract infections. Implementation of an evidence-based prevention program can significantly reduce both the prevalence of indwelling catheterization and the incidence of hospital-acquired catheter-associated urinary tract infection. This article describes the epidemiology and pathophysiology of catheter-associated urinary tract infection, and outlines essential elements of an evidence-based prevention program for the critical care unit.

Urologic Infections

2018 ◽  
Author(s):  
Tatyana Vayngortin ◽  
Nisa S Atigapramoj
Keyword(s):  
Urinary Tract Infection ◽  
Clinical Practice ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pediatric Patients ◽  
Age Groups ◽  
Rapid Identification ◽  
Bacterial Diseases ◽  
Key Words Antibiotics ◽  
Tract Infections

Urinary tract infections (UTIs) affect people of all ages. Although the incidence of invasive bacterial diseases continues to decline, the prevalence of UTIs in febrile pediatric patients continues to remain a focus for serious bacterial infection in this population. In older age groups, symptoms become more obvious and present more classically. Clinical practice guidelines have been developed because morbidity can be dependent upon the rapid identification of a UTI with prompt initiation of appropriate antimicrobials. This review provides a summary for the evaluation of UTIs with discussion of diagnosis and management.  This review contains 6 figures, 5 tables and 47 references Key words: antibiotics, cystitis, pyelonephritis, urinary tract infection, uropathogens

Urologic Infections

2018 ◽  
Author(s):  
Tatyana Vayngortin ◽  
Nisa S Atigapramoj
Keyword(s):  
Urinary Tract Infection ◽  
Clinical Practice ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pediatric Patients ◽  
Age Groups ◽  
Rapid Identification ◽  
Bacterial Diseases ◽  
Key Words Antibiotics ◽  
Tract Infections

Urinary tract infections (UTIs) affect people of all ages. Although the incidence of invasive bacterial diseases continues to decline, the prevalence of UTIs in febrile pediatric patients continues to remain a focus for serious bacterial infection in this population. In older age groups, symptoms become more obvious and present more classically. Clinical practice guidelines have been developed because morbidity can be dependent upon the rapid identification of a UTI with prompt initiation of appropriate antimicrobials. This review provides a summary for the evaluation of UTIs with discussion of diagnosis and management.  This review contains 6 figures, 5 tables and 47 references Key words: antibiotics, cystitis, pyelonephritis, urinary tract infection, uropathogens

scholarly journals Revisiting CAUTI Prevention: A Multifaceted Approach using Lean Six Sigma

2020 ◽  
pp. 1-64
Author(s):  
Lisa Ann Behrend
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Six Sigma ◽  
Infection Prevention ◽  
Comprehensive Evaluation ◽  
Lean Six Sigma ◽  
Evidence Based ◽  
Infection Rates ◽  
Tract Infections

This project identified gaps in policy and processes to improve patient outcomes related to workflow in the catheter-associated urinary tract infection policy and process at a 400-bed hospital in southern California. Even with an evidence-based infection prevention bundle in place, the current process was not working, as demonstrated by high catheter-associated infection rates for the last two years. This project answers the question: Does the use of a comprehensive evaluation of the current policy and process using the Lean Six Sigma quality improvement model influence a reduction in infection rates in patients who have an internal urinary catheter over 15 weeks? Despite published consensus guidelines for the diagnosis, prevention, and treatment of catheter-associated urinary tract infections; a single, evidence-based approach to the reduction of urinary tract infection does not exist. Avoiding the placement of catheters and encouraging early removal are the most effective interventions to prevent infection. The outcomes of the project resulted in a decrease in infections and significant cost reduction for the organization related to patient days and fines. Implementation of teams, nurse-driven protocols, and the establishment of bi-annual staff education were successful interventions. Lean Six Sigma played a significant role in the recognition of practical strategies required to ensure the effective use of proven infection prevention and to decrease the burden of disease correlated with indwelling urinary catheterization.

A STUDY OF URINARY TRACT ABNORMALITIES IN HOSPITALISED CHILDREN PRESENTING WITH URINARY TRACT INFECTION IN MIDNAPORE MEDICAL COLLEGE AND HOSPITAL

2021 ◽  
pp. 71-73
Author(s):  
Nabanita Das ◽  
Mitali Bera ◽  
Shabarna Roy ◽  
Dhruba Kumar Mahata
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Medical College ◽  
Number Of Children ◽  
The Mean ◽  
Tract Infections

Introduction: Urinary tract infection is the most common bacterial infection in childhood and upto 30% of infants and children experience recurrent infections during the rst 6 to 12 months after initial UTI. Urinary tract infections (UTI) imply invasion of urinary tract by pathogens, which may involve the upper or lower urinary tract depending on the infection in the kidney or bladder and urethra. Aims And Objectives: Children presenting with UTI by Ultrasonography, MCU and / or DMSA depending on the child's age. structural abnormalities and the presence of VUR if any in children with UTI by USG, MCU and DMSAscan in indicated cases. Materials And Methods: The study was conducted in the Pediatrics ward of Midnapore Medical College and Hospital. This is a tertiary care centre. Pediatric patients from different districts of West Bengal are referred to our Institute. All pediatric patients from 3 months to 12 years of age patients with a diagnosis of, either rst episode or recurrent UTI admitted at Midnapore Medical College and Hospital. Our study was an Observational, Prospective study. All the pediatric patients fullling the inclusion criteria, admitted to the hospital during the study period was enrolled for the study. Result And Analysis: We found in abnormal DMSA, the mean age (mean±s.d.) of children was 21.9375 ± 29.1398 years. In normal DMSA, the mean age (mean±s.d.) of children was 24.7321 ± 18.3179. In not required DMSA, the mean age (mean±s.d.) of children was 97.1667 ± 21.9855. Distribution of mean age in years vs. DMSAwas statistically signicant (p<0.0001). In abnormal DMSA, Conclusion: Even a normal USG report does not rule out dysfunctional bladder as we have had 3 children aged 19 months, 6 months and 26 months who had normal USG ndings but clear evidence of VUR on MCU of grades 2 ,4 and 1 respectively. In conclusion, abnormal US may carry a higher probability of grades III-VVUR and RS, and can affect the management in a signicant number of children hospitalized with UTI.

scholarly journals Impact of a urinary tract infection diagnostic and treatment algorithm for psychiatric inpatients with a communication barrier

2020 ◽  
Vol 10 (2) ◽  
pp. 55-59
Author(s):  
Christine Rarrick ◽  
Hannah Leschorn ◽  
Amy Hebbard
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Inappropriate Prescribing ◽  
Antibiotic Use ◽  
Autism Spectrum ◽  
Diagnosis And Treatment ◽  
Tract Infections

Abstract Introduction Differentiating between a urinary tract infection and asymptomatic bacteriuria is an important distinction to make, especially in noncommunicative patients. An algorithm meant to aid in the diagnosis and treatment of urinary tract infections in this population was implemented within a psychiatric emergency department in January 2019. The primary objective of this project was to assess the impact of the algorithm (the intervention) regarding symptom documentation and antibiotic use. Secondary objectives included assessing changes in inappropriate prescribing and urine culture orders. Methods Preintervention outcomes were measured from August 1, 2018, through November 30, 2018, while the postintervention cohort included patients admitted after January 31, 2019 and discharged before June 1, 2019. Adults admitted to psychiatry with a urinalysis ordered in the emergency department and an ICD-10 code representing dementia, delirium, autism spectrum disorder, or intellectual disability were included; pregnant patients were excluded. Results The preintervention (n = 56) and postintervention (n = 34) cohorts were well balanced with an average age of 66.5 and 70 years, respectively. Neurocognitive disorder was the diagnosis for inclusion in approximately two-thirds of both groups. Numerically, postalgorithm implementation, symptoms were documented more frequently (20.6% vs 10.7%, P = .23) and antibiotics used less often (2.9% vs 14.3%, P = .15). Inappropriate prescribing occurred in 12.5% of preintervention cohort compared to no patients postintervention (P = .04). Discussion The creation and implementation of an algorithm assisting in the diagnosis and treatment of urinary tract infections in noncommunicative patients was associated with a trend toward increased symptom documentation and decreased overall antibiotic use, and significantly increased appropriate antibiotic prescribing.

scholarly journals Prevalence of urinary tract infection in febrile preschool children

2019 ◽  
Vol 6 (2) ◽  
pp. 320
Author(s):  
Swatantar Singh ◽  
Sangeeta Parihar
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Preschool Children ◽  
Urinary Tract ◽  
Tract Infection ◽  
Outpatient Department ◽  
Causative Organism ◽  
Case Record ◽  
Loss Of Appetite ◽  
Tract Infections

Background: Children with fever is a common and comprise a substantial proportion of the practice in outpatient department and emergency department. Little attention has been focused on the identification of urinary tract infection (UTI) in febrile in infants and children in the emergency department, despite recent information that suggests a high prevalence of urinary tract infections and significant associated morbidity in these patients. The present study is undertaken to estimate the prevalence of urinary tract infection in febrile preschool children (less than 5 years of age) in febrile children.Methods: Febrile children less than 5 years attending outpatient department or admitted in Department of Paediatrics were enrolled into the study. Children below 1 month and above 5 years; any child who has received antibiotics 48 hours prior to evaluation; children with known congenital genitourinary anomalies; and were excluded from the study. Children with symptoms suggestive of UTI were interviewed using structured case record form (CRF). All symptomatic children were referred for urine routine microscopy and culture tests.Results: The prevalence of culture positive cases for UTI was 6.36%. Male infants and female infants affected equally. But females affected more in the age between 1 years to 5 years as compared to males. Apart from fever, the commonest symptoms were dysuria, abdominal pain, vomiting, chills and rigors and loss of appetite. More than two-third of the patients with CP-UTI have E. coli as causative organism for UTI. Overall most sensitive antimicrobials were Ceftriaxone.Conclusions: UTIs in preschool children are often having vague and variable symptoms, often fever is the only symptoms. An untreated UTI can lead to subsequent damage and impairment of renal structure and function, it is very important to diagnose and treat UTI in preschool children.

scholarly journals Reducing Catheter-Associated Urinary Tract Infection Project

2020 ◽  
Author(s):  
◽  
Beatriz Agado
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
The United States ◽  
Evidence Based ◽  
Rehabilitation Center ◽  
Post Intervention ◽  
Practice Problem ◽  
Tract Infections

Practice Problem: Catheter-associated urinary tract infections (CAUTIs) are prevalent and responsible for an estimated 13,000 deaths annually in the United States. Reported cases of CAUTIs remain disproportionately high at a rehabilitation center located in South Texas. PICOT: This evidence-based project answered the following question: In rehabilitation patients, what is the effect of a nurse-driven protocol (NDP) CAUTI bundle on the number of indwelling urinary catheter-related infections, compared to the current practice, over a 12-week time period? Evidence: Twenty high-quality studies that met the inclusion and exclusion criteria recommended using an NDP CAUTI bundle, education, and champions to round the unit to decrease the number of catheter-associated urinary tract infections. Intervention: The evidence-based intervention utilized the implementation of an NDP CAUTI bundle. The intervention bundle included catheter indication, hand hygiene, an insertion technique, maintenance, ongoing assessment to evaluate catheter need, and documentation. Outcome: The evaluation of the outcome measures demonstrated that the CAUTI rate decreased from six incidences in 2019 to two from January to May 2020. There were zero incidences during the project implementation from June to August 2020, and the number of catheter days decreased from 59% at baseline to 41% post-intervention. Conclusion: The implementation of a nurse-driven protocol CAUTI bundle, education, and champions in the unit were successful interventions that decreased the catheter-associated urinary tract infection rates in the rehabilitation center.

Urologic Infections

2018 ◽  
Author(s):  
Tatyana Vayngortin ◽  
Nisa S Atigapramoj
Keyword(s):  
Urinary Tract Infection ◽  
Clinical Practice ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pediatric Patients ◽  
Age Groups ◽  
Rapid Identification ◽  
Bacterial Diseases ◽  
Key Words Antibiotics ◽  
Tract Infections

Urinary tract infections (UTIs) affect people of all ages. Although the incidence of invasive bacterial diseases continues to decline, the prevalence of UTIs in febrile pediatric patients continues to remain a focus for serious bacterial infection in this population. In older age groups, symptoms become more obvious and present more classically. Clinical practice guidelines have been developed because morbidity can be dependent upon the rapid identification of a UTI with prompt initiation of appropriate antimicrobials. This review provides a summary for the evaluation of UTIs with discussion of diagnosis and management.  This review contains 6 figures, 5 tables and 47 references Key words: antibiotics, cystitis, pyelonephritis, urinary tract infection, uropathogens

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