scholarly journals Imprecision Medicine: Challenges in Diagnosis, Treatment, and Measuring Quality for Catheter-Associated Urinary Tract Infection

2020 ◽  
Vol 71 (9) ◽  
pp. e520-e522 ◽  
Author(s):  
Barbara W Trautner ◽  
Daniel J Morgan
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Patient Care ◽  
Antibiotic Use ◽  
Quality Metric ◽  
Quality Of Patient Care ◽  
True Infection

Abstract We question the reliability of the vague symptoms that most commonly define catheter-associated urinary tract infection (CAUTI) and encourage further examination of whether the current CAUTI definition reflects a true infection. While diagnosing CAUTI using the current surveillance definition, physicians may be missing a number of nonurinary etiologies for fever, prematurely diagnosing urinary tract infection, and prescribing unnecessary antibiotics. We believe it is time to reconsider the quality metric of CAUTI. By doing so, we can improve antibiotic use and quality of patient care.

589 Enhancing Care Providers’ CAUTI (Catheter-associated Urinary Tract Infection) Knowledge, Skills and Attitudes in the Burn Intensive Care Unit (BICU) and Burn Special Care (BSC) Environments

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S136-S137
Author(s):  
Emily Beckwith ◽  
Megan Zynkian
Keyword(s):  
Urinary Tract Infection ◽  
Quality Of Care ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Use ◽  
Special Care ◽  
Care Providers ◽  
Urinary Catheters ◽  
Pain And Suffering

Abstract Introduction CAUTIs, or Catheter-associated Urinary Tract Infection, are one of the leading causes of healthcare associated infections. Since 2008, Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospital for the cost of CAUTIs, forcing hospitals to modify and improve care provided to patients with indwelling urinary catheters (IUC). They are reportable events to CMS, which can signify the quality of care provided at any medical institution. These infections also cause extra pain and suffering and can complicate any hospital stay. Treatment requires antibiotic use, which helps create and spread antibiotic-resistant organisms with excessive use. Methods BICU and BSC staff were evaluated for knowledge of IUC care, maintenance and policies using a quiz dispersed to RNs. This quiz identified knowledge gaps to help focus on specific topics for training. During Skills Day, all Burn RNs were given a mandatory training, including a PowerPoint presentation, hands-on training performing catheter care, and a handout with quick tips for maintenance. All technical partners (TP) were also trained, though they were not given the quiz. To assess effectiveness of training, RNs were encouraged to take a post-training quiz. Rates of CAUTI will also be closely monitored. Results For the pre-training quiz, average scores were 13.1 correct answers (out of 23 questions) or 56.5%. Post-training quiz scores were 18.5 correct answers (out of 23 questions) or 81%. Since the training in September 2018, no new CAUTIs have been recorded. Conclusions The training provided helped enhance burn staff skills to maintain and care for indwelling urinary catheters, as well as changed attitudes on the unit. Applicability of Research to Practice CAUTIs are a reflection of the quality of care an institution and unit provides its patients. It is also closely monitored and used to compare similar units across the nation. The training provided to the burn staff has shown to decrease the number of CAUTIs in the Burn ICU and Burn Special Care environments, thus decreasing costs, pain and suffering and antibiotic use.

scholarly journals Cranberry Extract for Symptoms of Acute, Uncomplicated Urinary Tract Infection: A Systematic Review

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 12
Author(s):  
Oghenekome A. Gbinigie ◽  
Elizabeth A. Spencer ◽  
Carl J. Heneghan ◽  
Joseph J. Lee ◽  
Christopher C. Butler
Keyword(s):  
Clinical Trials ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Use ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Cochrane Library ◽  
Uncomplicated Urinary Tract Infection ◽  
Cranberry Juice

Background: Effective alternatives to antibiotics for alleviating symptoms of acute infections may be appealing to patients and enhance antimicrobial stewardship. Cranberry-based products are already in wide use for symptoms of acute urinary tract infection (UTI). The aim of this review was to identify and critically appraise the supporting evidence. Methods: The protocol was registered on PROSPERO. Searches were conducted of Medline, Embase, Amed, Cinahl, The Cochrane library, Clinicaltrials.gov and WHO International Clinical Trials Registry Platform. We included randomised clinical trials (RCTs) and non-randomised studies evaluating the effect of cranberry extract in the management of acute, uncomplicated UTI on symptoms, antibiotic use, microbiological assessment, biochemical assessment and adverse events. Study risk of bias assessments were made using Cochrane criteria. Results: We included three RCTs (n = 688) judged to be at moderate risk of bias. One RCT (n = 309) found that advice to consume cranberry juice had no statistically significant effect on UTI frequency symptoms (mean difference (MD) −0.01 (95% CI: −0.37 to 0.34), p = 0.94)), on UTI symptoms of feeling unwell (MD 0.02 (95% CI: −0.36 to 0.39), p = 0.93)) or on antibiotic use (odds ratio 1.27 (95% CI: 0.47 to 3.43), p = 0.64), when compared with promoting drinking water. One RCT (n = 319) found no symptomatic benefit from combining cranberry juice with immediate antibiotics for an acute UTI, compared with placebo juice combined with immediate antibiotics. In one RCT (n = 60), consumption of cranberry extract capsules was associated with a within-group improvement in urinary symptoms and Escherichia coli load at day 10 compared with baseline (p < 0.01), which was not found in untreated controls (p = 0.72). Two RCTs were under-powered to detect differences between groups for outcomes of interest. There were no serious adverse effects associated with cranberry consumption. Conclusion: The current evidence base for or against the use of cranberry extract in the management of acute, uncomplicated UTIs is inadequate; rigorous trials are needed.

scholarly journals Evaluation of ESBL (Extended Spectrum Beta-Lactamase) Producing Escherichia Coli Isolated from Patients with Urinary Tract Infection by Phenotypic and Genotypic Methods

2020 ◽  
Author(s):  
Mohammad Hasan Namaei ◽  
Hengameh Hamzei ◽  
Marzie Moghanni ◽  
Azadeh Ebrahimzadeh
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Use ◽  
M Gene ◽  
Esbl Producer ◽  
Accurate Identification ◽  
E Coli ◽  
Tract Infections

Abstract Background: Urinary Tract Infection (UTI) is the most common bacterial infection in the world. E. coli is the predominant Pathogen. This study evaluates the prevalence of ESBL in E. colis isolated from patients with urinary tract infections with phenotypic and genotypic methods.Methods: This descriptive-analytical study was done on 155 isolates of E. coli isolated from patients with urinary tract infection who had received the study consent. After accurate identification of E. coli strains. ESBL production for Escherichia coli isolates which are resistant to ceftriaxone or ceftazidime was evaluated by CDT method. TEM, SHV and CTX-M genes were identified by PCR.Results: The results showed that 30 strains from 155 strains of E. coli had ESBL. Strains of ESBL producer were more in males was lower in educated persons. 38.9% of ESBL producer had antibiotic use, 29.9% -producing Escherichia hospitalization and 31.6% uti history. The highest level of drug allergy in the ESBL was related to nitrofurantoin, and the highest resistance was related to cefazolin, co-trimoxazole. The CTX-M and the CTX-M15 gene were found in 92.7% and 57.1% of cases, respectively; also the SHV and TEM genes were not found in any of ESBL-producing Escherichia coli strains. Most therapeutic response in patients was related to cefexime, ciprofloxacin and nitrofurantoin 27.4%, 26% 21.9%, respectively.Conclusion: This study showed that the history of antibiotic use, hospitalization, uti related to increase of ESBL-producing in E. coli isolates., the CTMX-M gene is the most common gene in ESBL-producing E. coli strains.

scholarly journals Evaluation of BacterioScan 216Dx in Comparison to Urinalysis as a Screening Tool for Diagnosis of Urinary Tract Infections in Children

2019 ◽  
Vol 57 (9) ◽  
Author(s):  
Ferdaus Hassan ◽  
Heather Bushnell ◽  
Connie Taggart ◽  
Caitlin Gibbs ◽  
Steve Hiraki ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Predictive Value ◽  
Screening Tool ◽  
Urine Culture ◽  
Antibiotic Use ◽  
Urine Samples ◽  
Maldi Tof ◽  
Tract Infections

ABSTRACTUrinalysis (UA) has routinely been used as a screening tool prior to urine culture set up. BacterioScan 216Dx is an FDA-cleared semiautomated system to detect bacterial growth in urine. The aim of this study was to evaluate 216Dx in comparison to UA for diagnosis of urinary tract infection (UTI) in children. Clean-catch, unpreserved urine samples from children aged <18 years were tested by 216Dx, and positive urine samples in media were processed for direct bacterial identification by matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry. Sensitivity and specificity of 216Dx and urinalysis (UA) were determined against urine culture. Of 287 urine samples obtained from children (median age, 108 months), 44.0% and 56.0% were UA positive and negative, respectively, while 216Dx detected 27% and 73% as positive and negative, respectively. Compared to culture, the overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 216Dx versus UA were 92.1% versus 97.3%, 82.7% versus 63.8%, 44.8% versus 29.1%, and 98.6% versus 99.3%, respectively. Among 216Dx true-positive (TP) samples (n= 35), 77.0% were successfully identified directly from broth by MALDI-TOF. Among urine samples that were identified as contaminated by culture (n= 127; 44%), the 216Dx detected 93 (73.0%) as negative while UA detected 69 (54.0%) as negative. Although the sensitivities of 216Dx and UA are comparable, the specificity of 216Dx was higher than that of UA. The 216Dx can be used as an alternative/adjunct screening tool to UA to rule out urinary tract infection (UTI) in children. Compared to culture, the faster turnaround time (3 hours) of 216Dx has the potential to reduce unnecessary antibiotic use and improve patient management.

scholarly journals Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e035074
Author(s):  
Ingvild Vik ◽  
Ibrahimu Mdala ◽  
Marianne Bollestad ◽  
Gloria Cristina Cordoba ◽  
Lars Bjerrum ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Logistic Regression ◽  
Urinary Tract ◽  
Randomised Controlled Trial ◽  
Tract Infection ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Uncomplicated Urinary Tract Infection ◽  
Baseline Information ◽  
Randomised Controlled

ObjectiveTo predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI).Setting16 sites in a primary care setting in Norway, Sweden and Denmark.ParticipantsData from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen.MethodsUsing the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics.ResultsOf the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74).ConclusionWe did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate.Trial registration numberClinicalTrials.gov (NCT01849926).

Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis

2020 ◽  
Vol 39 (11) ◽  
pp. 2077-2083 ◽  
Author(s):  
Bérénice Souhail ◽  
Patrick Charlot ◽  
Gilles Deroudilhe ◽  
Yves Coblentz ◽  
Gregory Pierquet ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Use ◽  
Ureteral Stent ◽  
Stent Insertion

Maintenance of indwelling urinary catheters with a novel polyhexanide-based solution: user experience

2020 ◽  
Vol 29 (18) ◽  
pp. S18-S28
Author(s):  
Litti Andersen ◽  
Marianne Bertelsen ◽  
Vicki Buitenhuis ◽  
Annette Carstensen ◽  
Jane Hannibalsen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Healthcare Costs ◽  
Product Evaluation ◽  
Improve Quality ◽  
Urinary Catheters ◽  
User Experiences

Background: Catheter-associated urinary tract infection (CAUTI) can significantly affect patients' quality of life and increase healthcare costs. Aims: This study aimed to capture patients' and nurses' experience of catheter maintenance using a polyhexanide-based solution (PS) in everyday practice. Methods: Retrospective analysis of data was collected for a product evaluation. PS was used twice a week for five weeks. Findings: The study included 42 patients, 30 (71%) men and 12 women (29%). After five weeks of rinsing catheters with PS, nine patients reported no or decreased frequency of CAUTI, eight a better quality of life, eight reduced blockage, seven a decrease in odour and five fewer catheter changes. Three patients reported no benefit from PS use. Nurses reported that fewer visits were needed and consumption of disposables was lower. Conclusions: User experiences suggest that, as a novel means of catheter maintenance, PS has the potential to reduce catheter-associated complications such as CAUTI, improve quality of life and reduce healthcare costs.

scholarly journals Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection

2019 ◽  
Vol 28 (9) ◽  
pp. S4-S17 ◽  
Author(s):  
Anna Waskiewicz ◽  
Obrey Alexis ◽  
Deborah Cross
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Fluid Intake ◽  
Adult Population ◽  
Personal Hygiene ◽  
Reduce Risk ◽  
The Uk

More than 90 000 of the UK adult population are estimated to have a urinary catheter, with 24% likely to develop symptoms of catheter-associated urinary tract infection (CAUTI). The consequences of having a CAUTI are reduced quality of life, risk of hospitalisation and increased mortality. The authors undertook a literature review of primary research studies to identify how nurses could support patients to maintain effective catheter care to reduce the risk of CAUTI. Four themes emerged: education, knowledge, empowerment and communication. The authors therefore conclude that consistent knowledge, clear communication and treating patients as partners in the decision-making process can help build trust and allow empower patients. This will enable patients to make safe and healthy decisions about their catheter, particularly with regard to personal hygiene and optimal fluid intake, to reducing the risk of CAUTI.

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