Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center

2014 ◽  
Vol 35 (6) ◽  
pp. 685-691 ◽  
Author(s):  
H. L. Wald ◽  
B. Bandle ◽  
A. Richard ◽  
S. Min
Keyword(s):  
Urinary Tract ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Hospital ◽  
Reference Standard ◽  
Electronic Surveillance ◽  
Tract Infections ◽  
Sensitivity Specificity

Objective.To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).Design.Diagnostic accuracy study.Setting.A 425-bed university hospital.Subjects.A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods.An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results.Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.Conclusion.The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.Infect Control Hosp Epidemiol 2014;35(6):685–691

Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center

2014 ◽  
Vol 35 (06) ◽  
pp. 685-691 ◽  
Author(s):  
H. L. Wald ◽  
B. Bandle ◽  
A. Richard ◽  
S. Min
Keyword(s):  
Urinary Tract ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Hospital ◽  
Reference Standard ◽  
Electronic Surveillance ◽  
Tract Infections ◽  
Sensitivity Specificity

Objective.To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).Design.Diagnostic accuracy study.Setting.A 425-bed university hospital.Subjects.A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods.An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results.Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.Conclusion.The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.Infect Control Hosp Epidemiol2014;35(6):685–691

scholarly journals 1116. Impact of Antimicrobial Stewardship Incentive Goals for Pharmacists on Overall Antibiotic Use and Appropriate Duration of Therapy in Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S397
Author(s):  
Matthew A Miller ◽  
Mattie Huffman ◽  
Nichole Neville ◽  
Misha Huang ◽  
Gerard Barber
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Group Performance ◽  
Respiratory Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Days Of Therapy ◽  
Essential Resource ◽  
Tract Infections

Abstract Background Urinary tract (UTI), skin and soft tissue, and respiratory infections are among the most frequently reported indications for antibiotics, such that focusing stewardship efforts here would expectedly have dramatic effects. Antimicrobial stewardship (AMS) programs vary in structure and available resources. At the University of Colorado Hospital, a 740-bed academic medical center, dedicated resources for AMS are limited to a pharmacist, pharmacy resident, and physician; however, there is a large clinical pharmacist group. For the past 2 years, pharmacy management incorporated AMS targets as group goals tied to performance bonuses. Methods This is a descriptive report utilizing incentives to achieve AMS goals. The first goal (July 1, 2016 to June 30, 2017) set out to reduce inpatient antibiotic use by 10%. The second goal (July 1, 2018 to June 30, 2018) was a 10% reduction in median antibiotic duration for UTIs. The AMS team provided guidelines, education, and oversight throughout target periods. Antibiotic use was calculated as days of therapy (DOT) per 1000 patient-days. Data related to UTI treatment was collected retrospectively on a quarterly basis. This was compared with baseline data previously collected during a statewide hospital stewardship collaborative project. Results During the first period, overall antibiotic use declined from 497 to 403 DOT per 1000 patient-days (18.9%), and broad-spectrum antibiotic use declined 22%. During the second period, 30 patient charts were reviewed quarterly, and the median UTI duration declined from 10 to 7 days (P = 0.002). The most common UTI diagnoses were similar between periods with complicated cystitis and pyelonephritis comprising 60–70% of cases. The 30-day readmission rate was not different between the baseline and goal period, 11% vs. 6% respectively (P = 0.18). Conclusion The use of group pharmacist goals tied to annual performance bonuses was effective in achieving AMS goals at our institution. In larger facilities with fewer dedicated AMS personnel, clinical pharmacists covering ward and intensive care units are an essential resource to achieving AMS goals. Group performance incentives may be a feasible strategy to generate interest and motivation to achieve AMS program goals. Disclosures All authors: No reported disclosures.

scholarly journals Epidemiology of Hospital-Acquired Urinary Tract–Related Bloodstream Infection at a University Hospital

2011 ◽  
Vol 32 (11) ◽  
pp. 1127-1129 ◽  
Author(s):  
Robert Chang ◽  
M. Todd Greene ◽  
Carol E. Chenoweth ◽  
Latoya Kuhn ◽  
Emily Shuman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Bloodstream Infection ◽  
Case Fatality Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Case Fatality ◽  
University Hospital ◽  
Academic Medical ◽  
Hospital Acquired

Little is known about the epidemiology of nosocomial urinary tract-related bloodstream infection. In a case series from an academic medical center, Enterococcus (28.7%) and Candida (19.6%) species were the predominant microorganisms, which suggests a potential shift from gram-negative microorganisms. A case-fatality rate of 32.8% highlights the severity of this condition.

Comparison of DMSA Scintigraphy and USG in Detecting Renal Cortical Scars in Children with Urinary Tract Infection

2018 ◽  
Vol 13 (03) ◽  
pp. 210-215
Author(s):  
Fatma Taşbent ◽  
Özlem Şahin
Keyword(s):  
Urinary Tract ◽  
Predictive Value ◽  
Renal Damage ◽  
Renal Scarring ◽  
Imaging Techniques ◽  
Dmsa Scintigraphy ◽  
Multiple Imaging ◽  
Tract Infections ◽  
Sensitivity Specificity ◽  
Parenchymal Damage

Objective Multiple imaging techniques may be used to evaluate the development of progressive renal damage in children with urinary tract infections (UTIs). The aim of this study was to compare the efficacy of Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy and renal ultrasonography (USG) in detecting renal scars in children with UTIs. Methods A total of 630 kidneys from 364 children were included in the study and the results of DMSA and USG of children with UTIs were evaluated retrospectively between January 2016 and October 2017. DMSA scintigraphy is accepted as the gold standard and it was compared with USG results. Results The sensitivity, specificity, positive predictive value, and negative predictive value for USG in the detection of renal scarring was found as 57.1, 89.6, 40.8, and 94.4%, respectively. Conclusions Although USG is known to be safe, readily available, and relatively inexpensive, the sensitivity of USG does not seem to be sufficient to identify the renal parenchymal damage. We concluded that USG cannot replace DMSA in the evaluation of renal scarring.

scholarly journals Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center

2017 ◽  
Vol 38 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Abigail L. Carlson ◽  
Satish Munigala ◽  
Anthony J. Russo ◽  
Kathleen M. McMullen ◽  
Helen Wood ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Laboratory Data ◽  
Surgical Intensive Care ◽  
Tertiary Referral Center ◽  
Patient Admissions ◽  
Academic Medical ◽  
Tract Infections

OBJECTIVETo describe the frequency of urine cultures performed in inpatients without additional testing for pyuriaDESIGNRetrospective cohort studySETTINGA 1,250-bed academic tertiary referral centerPATIENTSHospitalized adultsMETHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.Infect Control Hosp Epidemiol2017;38:455–460

scholarly journals Macroscopy and Microscopy Urinalysis: A Vital Screening Procedure for Urinary Tract Infections (UTIs) in a Hospital in Awka, Nigeria

2020 ◽  
Vol 11 (1) ◽  
pp. 143
Author(s):  
Uchechukwu G. Nwankwo ◽  
Chinenye U. Ezebialu ◽  
Joachim O. Ezeadila ◽  
Ikechukwu Okoli
Keyword(s):  
Urinary Tract ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Urine Culture ◽  
Positive Urine ◽  
Microscopic Features ◽  
Tract Infections ◽  
Sensitivity Specificity ◽  
Urine Microscopy ◽  
Urine Colour

Urine examination has been employed in clinical practice as the most common screening laboratory method for early detection of urinary tract infections (UTIs) or renal disorder. This study was undertaken to ascertain the usefulness of urine macroscopy and microscopy as vital screening procedure for diagnosing UTI among antenatal patients in a teaching hospital in Awka, Nigeria. Freshly voided midstream urine specimens of 269 pregnant women were collected and examined using macroscopic, microscopic and culture methods. The sensitivity, specificity, positive predictive value and negative predictive value of urine colour, and microscopic features were compared with urine culture in diagnosis of UTI. Statistical analysis was done using SPSS and Epi info® and P-value was set at <0.05 significant level. One hundred and seven specimens showed positive urine cultures. Out of these 107 specimens, 60 (56.1%) also had deviation from normal urine colour and 77(72%) were positive on urine microscopy. Macroscopic examination showed that a significant relationship exists between urine colour and positive urine culture (p=0.0001). The sensitivity and specificity of urine colour with respect to UTI were 56.7% and 67.9% respectively. Urine microscopy revealed that the positive features had a significant relationship with positive urine culture (p= 0.000). Pyuria alone showed the specificity and positive predictive value of 100% each. The sensitivity, specificity, positive predictive value and the negative predictive value of combination of positive microscopic features were 72%, 64.8%, 57.5% and 77.8% respectively. Examination of colours and microscopic features of urine are therefore vital in predicting urinary tract infection.

Real-World Experience Using Cefpodoxime and Cefuroxime Axetil for Urinary Tract Infections at a Large Academic Medical Center

2020 ◽  
Vol 29 (1) ◽  
pp. e27-e31
Author(s):  
Hongkai Bao ◽  
Shin-Pung Jen ◽  
Xian Jie (Cindy) Chen ◽  
Justin Siegfried ◽  
Vinh P. Pham ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Real World ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cefuroxime Axetil ◽  
Academic Medical ◽  
Tract Infections
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