1432. Patient-Reported Urinary Tract Infection Symptoms Among Veterans with Neurogenic Bladder

Background Urinary tract infections (UTIs) and asymptomatic bacteria (AB) are common in patients with neurogenic bladder (NB) but differentiating between the two is challenging because laboratory tests cannot distinguish AB from UTI. This diagnostic uncertainty can lead to antibiotic overuse. Characterization of patient-reported symptoms from large cohorts of patients with NB can inform interventions to improve appropriate UTI diagnosis and management. Methods Retrospective cohort study of 1,797 adults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), and/or Parkinson’s Disease (PD) accounted for 568 patients with UTI encounters (via ICD10) at 4 Veterans Affairs (VA) medical centers between 2017-2018. Demographic and clinical data were collected from national VA datasets. Medical record review was performed on a random sample of 198 encounters. Chi-square/Fisher’s exact test were used to compare symptoms by patient and encounter characteristics. Results Among the 198 encounters (mean age=65 years), 33% of patients had SCI/D, 29% PD, 20% MS, and 17% had more than one diagnosis. Most encounters were for men (88%) in inpatient or long-term care settings (62%). 76% of patients used bladder catheters; most indwelling (n=92). Fever was the most frequent symptom (30%), followed by change in urine odor, color, and/or consistency (26%) and lethargy/malaise (21%). Only 38% of encounters had a urinary tract-specific symptom recorded (e.g., dysuria); 81% had non-specific symptoms (e.g., fever, lethargy). 64% of encounters were deemed an appropriate UTI diagnosis. Characteristics in red in Figure 1 were significantly associated with non-specific symptoms (p< 0.05). Patient and encounter characteristics found to be significantly associated with non-specific symptoms, p < 0.05. Conclusion Symptoms not specific to the urinary tract are the most frequently reported symptoms in patients with NB and encounters with a UTI diagnosis. Change in urine odor/color were reported often; however, guidelines recommend against using these for UTI diagnosis. Providers should ensure that alternate sources of non-specific symptoms are evaluated prior to attributing them to UTI. Antibiotic stewardship interventions targeted to physical medicine and rehabilitation (PM&R) and primary care providers in inpatient settings may improve UTI diagnosis in patients with NB. Disclosures Charlesnika T. Evans, PhD, MPH, BioK+ (Consultant)

Assessment of a Potential UTI–Using Videos to Analyze a Simulated Nursing Home Experience

In the past, urinary tract infections (UTIs) have been attributed to poor hygiene, the natural course of aging, an unfortunate corollary of nursing home (NH) residence, and a condition routinely treated empirically with antibiotics. Recent UTI management consensus statements foretell a very different future and support the need to consider all UTIs in the NH as complex infections. Improving assessment capabilities of the NH nurse workforce is essential for improving quality of care. This study aimed to determine how, using simulation, licensed vocational nurses (LVNs) integrated a mobile decision-support app (MDS-app) into assessment of a NH resident with a potential UTI. The MDS-app directed the LVN to examine or question the resident (mannequin) to identify signs and symptoms developed as part of a simulated clinical scenario. MDS-app items were based on UTI practice guidelines. A descriptive, participant observation design (video-taped) was used with ten practicing LVNs. An observation checklist was used to examine audiovisual recordings and included frequency of verbal interaction (17.9+/-7.2), and eye contact (10.6+/-4.1). Participants (47%) were “glued to” the MDS-app without making resident eye contact or touching residents during the assessment. 60% of participants deviated from the app to ascertain urine odor and color; irrelevant symptoms for UTI diagnosis. Assessments required 11.20 (+/-4.67) minutes to complete. The MDS-app provided LVNs with needed focus on data driven by guidelines and not individual LVN preferences. Training LVNs should focus on integration of communication, assessment skills, and MDS-app use for evidence-based data collection as a basis for UTI treatment decisions.

Experimental Evaluation of Spontaneous Olfactory Discrimination in Two Nocturnal Primates (Microcebus murinus and M. lehilahytsara)

Solitary species often employ chemocommunication to facilitate mate localization. In the solitarily foraging, nocturnal mouse lemurs (Microcebus spp.), females advertise their short period of estrus acoustically and by increased scent marking, whereas males search widely for receptive females. Both sexes can be trained by operant conditioning to discriminate conspecific from heterospecific urine scent. However, it is not known, if males during and outside the reproductive season show different spontaneous interest in conspecific female urine, and if urine from estrous females elicits a higher investigation response than that from diestrous females. We established a spontaneous discrimination paradigm and quantified olfactory investigation responses of 21 captive male mouse lemurs of M. lehilahytsara and M. murinus when presenting 1 conspecific and 1 heterospecific female urine odor sample simultaneously. Overall, M. murinus investigated stimuli significantly longer than M. lehilahytsara. Moreover, males of M. murinus showed significantly longer olfactory investigation at conspecific urine samples during but not outside the reproductive season. This indicates that female urinary cues are spontaneously discriminated by male M. murinus and that this discrimination is more relevant during the reproductive season. However, males of both species did not show different responses toward urine samples from estrous versus diestrous females. Finally, male age did not correlate with the overall duration of olfactory investigation, and investigation levels were similar when testing with fresh or frozen urine samples. In conclusion, this new spontaneous discrimination paradigm provides a useful additional tool to study olfactory communication of nocturnal primates from the receiver’s perspective.

Review and Comparison of Cancer Biomarker Trends in Urine as a Basis for New Diagnostic Pathways

Cancer is one of the major causes of mortality worldwide and its already large burden is projected to increase significantly in the near future with a predicted 22 million new cancer cases and 13 million cancer-related deaths occurring annually by 2030. Unfortunately, current procedures for diagnosis are characterized by low diagnostic accuracies. Given the proved correlation between cancer presence and alterations of biological fluid composition, many researchers suggested their characterization to improve cancer detection at early stages. This paper reviews the information that can be found in the scientific literature, regarding the correlation of different cancer forms with the presence of specific metabolites in human urine, in a schematic and easily interpretable form, because of the huge amount of relevant literature. The originality of this paper relies on the attempt to point out the odor properties of such metabolites, and thus to highlight the correlation between urine odor alterations and cancer presence, which is proven by recent literature suggesting the analysis of urine odor for diagnostic purposes. This investigation aims to evaluate the possibility to compare the results of studies based on different approaches to be able in the future to identify those compounds responsible for urine odor alteration.