scholarly journals Comparison of CRB/CRB-65, qSOFA, and SIRS for Risk Prediction in Patients with Urinary Tract Infection

2020 ◽  
Author(s):  
Sung Jin Bae ◽  
Jae Hee Lee ◽  
Yoon Hee Choi
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Hospital Mortality ◽  
Sensitivity And Specificity ◽  
Early Recognition ◽  
Medical Center ◽  
Baseline Characteristic ◽  
Icu Admission

Abstract Background: Early recognition of sepsis is critical for improving patient outcomes. In approximately 20%-30% of patients, sepsis resulted from urinary tract infection (UTI). This study aimed to investigate the effectiveness of CRB (confusion, respiratory rate, blood pressure), CRB-65, and quick sequential organ failure assessment (qSOFA) in predicting intensive care unit (ICU) admission and in-hospital mortality of patients with UTI and compare them with Systemic Inflammatory Response Syndrome (SIRS). Methods: This retrospective cohort study included patients with UTI who visited the emergency department of a single medical center between February 2018 and March 2020. Baseline characteristic data were obtained and compared with the prevalence of ICU admission and in-hospital mortality. The effectiveness of CRB, CRB-65, qSOFA, and SIRS as indicators of ICU admission and in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. Results: Overall, 1151 patients were included in this study, of whom 132 (11.5%) were admitted to the ICU and 30 (2.6%) succumbed to in-hospital mortality. AUROC values of CRB, CRB-65, and qSOFA as predictors of ICU admission and in-hospital mortality were similar. The CRB score of ≥1 had a sensitivity and specificity of 71.3% and 73.5%, respectively, for ICU admission and 66.7% and 69.2%, respectively, for in-hospital mortality. The CRB-65 score of ≥2 had a sensitivity and specificity of 61.2% and 80.9%, respectively, for ICU admissions and 60% and 76.9%, respectively, for in-hospital mortality. The qSOFA score of ≥1 had a sensitivity and specificity of 71.3% and 79.6%, respectively, for ICU admission and 66.7% and 74.8%, respectively, for in-hospital mortality. Conclusion: CRB, CRB-65, and qSOFA were more effective predictors than SIRS for patients with UTI. CRB, CRB-65, and qSOFA had similar general values for predicting outcomes in patients with UTI in the emergency department.

National Trends in Emergency Department Antibiotic Prescribing for Elders with Urinary Tract Infection, 1996-2005

2009 ◽  
Vol 16 (6) ◽  
pp. 500-507 ◽  
Author(s):  
Jeffrey M. Caterino ◽  
Sarah Grace Weed ◽  
Janice A. Espinola ◽  
Carlos A. Camargo, Jr
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Prescribing ◽  
National Trends

THE URINARY MANIFESTATIONS OF ANXIETY IN CHILD

PEDIATRICS ◽  
1973 ◽  
Vol 52 (6) ◽  
pp. 818-822
Author(s):  
Richard Galdston ◽  
Alan D. Perlmutter
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Medical Center ◽  
Children's Hospital ◽  
Hospital Medical ◽  
Intrapsychic Conflict ◽  
Children’S Hospital ◽  
Psychiatric Manifestations

This report comprises concurrent studies of the urologic and psychiatric manifestations of intrapsychic conflict among a group of children who had been admitted to the surgical wards of The Children's Hospital Medical Center, Boston, between 1965 to 1970 for complaints of disordered urination. Experience with these children indicates that anxiety can alter the frequency and disturb the adequacy of voiding to a degree sufficient to dispose the child to urinary tract infection. This effect of anxiety can occur both in the presence or absence of a demonstrable anatomic lesion. It suggests that an assessment of the degree and nature of the child's anxiety should be an integral part of the pediatric urologic examination.

Safety assessment and diagnostic evaluation of patients undergoing contrast-enhanced urosonography in the setting of vesicoureteral reflux confirmation

2021 ◽  
pp. 1-9
Author(s):  
Constantin A. Marschner ◽  
Vincent Schwarze ◽  
Regina Stredele ◽  
Matthias F. Froelich ◽  
Johannes Rübenthaler ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Vesicoureteral Reflux ◽  
Sensitivity And Specificity ◽  
Diagnostic Tool ◽  
High Sensitivity ◽  
Upper Urinary Tract ◽  
Clinical Diagnostics ◽  
Voiding Cystourethrography

BACKGROUND: Vesicoureteral reflux (VUR) represents a common pediatric anomaly in children with an upper urinary tract infection (UTI) and is defined as a retrograde flow of urine from the bladder into the upper urinary tract. There are many diagnostic options available, including voiding cystourethrography (VCUG) and contrasted-enhanced urosonography (ceVUS). ceVUS combines a diagnostic tool with a high sensitivity and specificity which, according to previous study results, was even shown to be superior to VCUG. Nevertheless, despite the recommendation of the EFSUMB, the ceVUS has not found a widespread use in clinical diagnostics in Europe yet. MATERIALS AND METHODS: Between 2016 and 2020, 49 patients with a marked female dominance (n = 37) were included. The youngest patient had an age of 5 months, the oldest patient 60 years. The contrast agent used in ceVUS was SonoVue®, a second-generation blood-pool agent. All examinations were performed and interpreted by a single experienced radiologist (EFSUMB Level 3). RESULTS: The 49 patients included in the study showed no adverse effects. 51%of patients (n = 26) were referred with the initial diagnosis of suspected VUR, while 49%of patients (n = 23) came for follow-up examination or to rule out recurrence of VUR. The vast majority had at least one febrile urinary tract infection in their recent medical history (n = 45; 91,8%). CONCLUSION: ceVUS is an examination method with a low risk profile which represents with its high sensitivity and specificity an excellent diagnostic tool in the evaluation of vesicoureteral reflux, especially in consideration of a generally very young patient cohort.

scholarly journals Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Sarah C J Jorgensen ◽  
Samantha L Yeung ◽  
Mira Zurayk ◽  
Jill Terry ◽  
Maureen Dunn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Treatment Algorithm ◽  
Rapid Change ◽  
Audit And Feedback ◽  
Prescribing Practices ◽  
Return Visits

Abstract Background The complex and fast-paced emergency department (ED) practice setting presents unique challenges that demand a tailored approach to antimicrobial stewardship. In this article, we describe the strategies applied by 1 institution’s antimicrobial stewardship program (ASP) that were successful in improving prescribing practices and outcomes for urinary tract infection (UTI) in the ED. Methods Core strategies included pre-implementation research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior, and morbidity related to infection; collaboration across multiple disciplines; development and implementation of a UTI treatment algorithm; education to increase awareness of the algorithm and the background and rationale supporting it; audit and feedback; and early evaluation of post-implementation outcomes. Results We observed a rapid change in prescribing post-implementation with increased empiric nitrofurantoin use and reduced cephalosporin use (P < .05). Our elevation of nitrofurantoin to firstline status was supported by our post-implementation analysis showing that its use was independently associated with reduced 30-day return visits (adjusted odds ratio, 0.547; 95% confidence interval, 0.312–0.960). Furthermore, despite a shift to a higher risk population and a corresponding decrease in antimicrobial susceptibility rates post-implementation, the preferential use of nitrofurantoin did not result in higher bug-drug mismatches while 30-day return visits to the ED remained stable. Conclusions We demonstrate that an outcomes-based ASP can impart meaningful change to knowledge and attitudes affecting prescribing practices in the ED. The success of our program may be used by other institutions as support for ASP expansion to the ED.

Risk Factors for Postoperative Urinary Tract Infection and Urinary Retention in Patients Undergoing Surgery for Colorectal Cancer

2012 ◽  
Vol 78 (10) ◽  
pp. 1100-1104 ◽  
Author(s):  
Celeste Y. Kang ◽  
Obaid O. Chaudhry ◽  
Wissam J. Halabi ◽  
Vinh Nguyen ◽  
Joseph C. Carmichael ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Urinary Tract Infection ◽  
Logistic Regression ◽  
Urinary Tract ◽  
Tract Infection ◽  
Hospital Mortality ◽  
Urinary Retention ◽  
Surgical Patients ◽  
Independent Risk Factors

The aim of this study was to analyze risk factors for postoperative urinary tract infection (UTI) and urinary retention (UR) in patients with colorectal cancer. Using Nationwide Inpatient Sample 2006–2009, a retrospective analysis of surgical patients with colorectal cancer was conducted. Patients were stratified into groups, with or without UTI/UR. The LASSO algorithm for logistic regression identified independent risk factors. A total of 93,931 surgical patients with colorectal cancer were identified. The incidences of UTI and UR were 5.91 and 2.52 per cent, respectively. Overall in-hospital mortality was 2.68 per cent. The UTI group demonstrated significantly higher in-hospital mortality rates compared with those without. Both UTI and UR groups were associated with prolonged hospital stay and increased hospital charge. Multivariate logistic regression analysis revealed age older than 60 years, females, anemia, congestive heart failure, coagulopathy, diabetes with chronic complications, fluid and electrolyte, paralysis, pulmonary circulation disorders, renal failure, and weight loss were independent risk factors of UTI. Age older than 60 years, male gender, rectal and rectosigmoid cancers, and postoperative anastomotic leakage and ileus were independent risk factors for UR. Postoperative UTI increases in-house mortality. Postoperative UTI/UR in patients with colorectal cancer increases length of stay and hospital charges. Knowledge of these specific risk factors for UTI and UR is needed to counsel patients and prevent these complications in this high-risk population.

Risk factors for early return visits to the emergency department in patients with urinary tract infection

2018 ◽  
Vol 36 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Sarah Jorgensen ◽  
Mira Zurayk ◽  
Samantha Yeung ◽  
Jill Terry ◽  
Maureen Dunn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Early Return ◽  
Return Visits
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