scholarly journals 3 UTI Diagnosis and Management in the Over 65s According to Public Health England Guidelines

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
H G T Brice ◽  
N Doherty ◽  
C Biss ◽  
T Quigley
Keyword(s):  
Public Health ◽  
Cell Count ◽  
Educational Intervention ◽  
Guideline Adherence ◽  
Urine Culture ◽  
White Cell Count ◽  
Asymptomatic Bacteriuria ◽  
White Cell ◽  
Urine Samples ◽  
Tract Infections

Abstract Introduction The diagnosis of urinary tract infections (UTI) becomes increasingly difficult with age. Dipsticks are unreliable and with the prevalence of asymptomatic bacteriuria increasing to 17% in females over 75 even urine culture results can be unreliable. Public Health England (PHE) released new guidelines in November 2018 with criteria for diagnosing UTIs in the over 65s. Methods Identify patients over 65 who are diagnosed with a UTI in Solihull acute medical unit. Collect data on presenting symptoms, dipstick and culture results and antibiotic use. Aim to improve guideline adherence and decrease dipstick use through education of medical and nursing staff via presentations and posters. Results Prior to the educational intervention guideline adherence when diagnosing UTIs in over 65s was 55%. This rose to 82% following the educational intervention. Dipstick usage decreased from 49% to 28% following the intervention. Dipsticks were shown to be unreliable as 21.6% of dipstick positive urine samples sent for culture had a normal (0-80) white cell count in the laboratory, whilst 43.8% of dipstick negative urine samples sent for culture had a raised white cell count in the laboratory. On retrospective analysis 16.1% of patients treated for a UTI appeared to have had an asymptomatic bacteriuria. Co-amoxiclav was initially used for 51% of patients however there was resistance to Co-amoxiclav in 31% of samples where an organism was cultured. Conclusions The educational intervention was able to increase PHE guideline adherence for diagnosing UTIs in the over 65s. There was also a decrease in the use of dipsticks which were shown to be unreliable in this age group. Prescribers remained reliant on broad-spectrum antibiotics with Co-Amoxiclav being most commonly used. This is likely to be ineffective in a significant number of patients given the common resistance seen in urine culture sensitivities.

scholarly journals Significant bacteriuria among requested repeat urine samples and its clinical correlation

2021 ◽  
Author(s):  
Arjun Bhugra ◽  
Supriya Gachinmath
Keyword(s):  
Escherichia Coli ◽  
Bacterial Infections ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Urine Samples ◽  
Clinical Correlation ◽  
Normal Flora ◽  
Sensitivity Pattern ◽  
Significant Bacteriuria ◽  
Tract Infections

Background and Objectives: Urinary tract infections (UTI) are the most common bacterial infections in both outpatient and inpatient department received for routine bacterial culture and sensitivity. We looked for significant bacteriuria in re- quested repeat urine sample after primary urine culture yielded significant growth (>105  CFU/ml) of ≥3 types of colonies. Also studied, different isolates grown with their sensitivity pattern and contamination rates of urine samples from different departments. Materials and Methods: In routine, primary urine cultures yielding ≥3 types of colonies on Cystine Lactose Electrolyte Deficient (C.L.E.D) were requested for repeat samples, collected with aseptic precautions after proper instructions. Data was analyzed for the Microbiological profile and its clinical correlation. Results: Among 617 received requested urine samples, 292 (47.3%) yielded significant bacteriuria. Clinical details were available for 252 cases out of which 100 (39.7%) showed asymptomatic bacteriuria, 87 (34.5%) complicated UTI and 65 (25.7%) uncomplicated UTI. Null hypothesis was rejected as 292 (47.3%) of the received repeat samples showed significant bacteriuria and 325 (53%) showed normal flora/no growth i.e. there is a 50% chance of getting either a positive culture or normal flora/no growth in repeat urine samples after the primary urine culture showed ≥3 types of colonies. It indicates the importance of requesting repeat urine samples for an accurate urine culture report. Male patients were significantly associ- ated with significant bacteriuria and complicated UTI (p= 0.001). Escherichia coli (n=112, 28%) was the most common fol- lowed by Klebsiella species (n=66, 16.4%) and Enterococcus species (n=69, 17.2%). 183 (45.6%) isolates were Multi-Drug Resistant (MDR) Gram Negative Bacilli (GNBs), Escherichia coli (50.3%) being most common. Vancomycin Resistant Enterococcus (VRE) (n=8, 2.0%) was also isolated. Conclusion: Our study justifies the rationale for asking a repeat urine samples which helps in providing an appropriate mi- crobiological report with antibiotic sensitivity pattern, hence preventing unwanted reporting of commensals/contaminants facilitating evidence based therapy.

Leucocytes and Thrombosis

1973 ◽  
Vol 30 (01) ◽  
pp. 036-046 ◽  
Author(s):  
D.C Banks ◽  
J.R.A Mitchell
Keyword(s):  
Cell Count ◽  
White Cell Count ◽  
Cell Loss ◽  
White Cell ◽  
Structural Resemblance ◽  
The Masses

SummaryWhen heparinised blood is rotated in a glass flask at 37°C. the white cell count falls and it has been shown that this is due to the adherence and aggregation of polymorphonuclear white cells on the wall of the flask. The masses formed bear a close structural resemblance to thrombi and the mechanisms involved in white cell loss during rotation may therefore increase our knowledge of the thrombotic process.

An Assessment of Red Cell Deformability Using a Simple Filtration Method

1979 ◽  
Author(s):  
M Drummond ◽  
G Lowe ◽  
J Belch ◽  
C Forbes ◽  
J Barbenel
Keyword(s):  
Cell Count ◽  
Shear Viscosity ◽  
White Cell Count ◽  
White Cell ◽  
Red Cell ◽  
Cell Deformability ◽  
Red Cell Deformability ◽  
Simple Method ◽  
Filtration Method ◽  
Significant Difference

We investigated the reproducibility and validity of a simple method of measuring red cell deformability (filtration of whole blood through 5 µ sieves) and its relationship to haematocrit, blood viscosity, fibrinogen, white cell count, sex and smoking. The mean coefficient of variation in normals was 3. 7%. Tanned red cells showed marked loss of deformability. Blood filtration rate correlated with haematocrit (r = 0. 99 on dilution of samples, r = 0. 7 in 120 normals and patients). After correction for haematocrit, deformability correlated with high shear viscosity, but not low shear viscosity, fibrinogen or white cell count. In 60 normals there was no significant difference between males and females, or smokers and non-smokers, but in 11 smokers there was an acute fall in deformability after smoking 3 cigarettes (p<0. 05). Reduced deformability was found in acute myocardial infarction (n = 15, p<0. 01) and chronic peripheral arterial disease (n = 15, p<0. 01). The technique is reproducible, detects rigid cells and appears useful in the study of vascular disease.

scholarly journals The use of routine blood tests to assist the diagnosis of COVID-19 in symptomatic hospitalized patients

2021 ◽  
pp. 000456322199907
Author(s):  
IT Parsons ◽  
AT Parsons ◽  
E Balme ◽  
G Hazell ◽  
R Gifford ◽  
...  
Keyword(s):  
Cell Count ◽  
Retrospective Review ◽  
Blood Test ◽  
Patient Flow ◽  
White Cell Count ◽  
Area Under The Curve ◽  
White Cell ◽  
Test Results ◽  
Rt Pcr ◽  
Blood Tests

Introduction Specific patterns of blood test results are associated with COVID-19 infection. The aim of this study was to identify which blood tests could be used to assist in diagnosing COVID-19. Method A retrospective review was performed on consecutive patients referred to hospital with a clinical suspicion of COVID-19 over a period of four weeks. The patient’s clinical presentation and severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction (SARS-CoV-2 RT-PCR) were recorded. The patients were divided by diagnosis into COVID (COVID-19 infection) or CONTROL (an alternate diagnosis). A retrospective review of consecutive patients over a further two-week period was used for the purposes of validation. Results Overall, 399 patients (53% COVID, 47% CONTROL) were analysed. White cell count, neutrophils and lymphocytes were significantly lower, while lactate dehydrogenase and ferritin were significantly higher, in the COVID group in comparison to CONTROL. Combining the white cell count, lymphocytes and ferritin results into a COVID Combined Blood Test (CCBT) had an area under the curve of 0.79. Using a threshold CCBT of –0.8 resulted in a sensitivity of 0.85 and a specificity of 0.63. Analysing this against a further retrospective review of 181 suspected COVID-19 patients, using the same CCBT threshold, resulted in a sensitivity of 0.73 and a specificity of 0.75. The sensitivity was comparable to the SARS-CoV-2 RT PCR. Discussion Mathematically combining the blood tests has the potential to assist clinical acumen allowing for rapid streaming and more accurate patient flow pending definitive diagnosis. This may be of particular use in low-resource settings.

A study in correlation of the sedimentation test, filament-nonfilament, and the white cell count in gynecology

1933 ◽  
Vol 25 (2) ◽  
pp. 203-212 ◽  
Author(s):  
H. Wellington Yates ◽  
David M. Davidow ◽  
Elizabeth Putnam ◽  
Frances Ellman
Keyword(s):  
Cell Count ◽  
White Cell Count ◽  
White Cell
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