Clinical Features in Nursing Home Residents with Suspected UTI

疑似尿路感染的疗养院居民的临床特征

• 批准号: 7201957
• 负责人: MANISHA JUTHANI-MEHTA
• 金额: $ 6.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-03-01 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7201957
• 关键词: Acute; Adopted; Adult; Adverse drug effect; Age; Antibiotic Therapy; Antibiotic-resistant organism; Antibiotics; Area; Bacteremia; Bacteria; Bacterial Infections; Bacteriuria; Cessation of life; Chronic; Clinical; Cohort Studies; Colony-forming units; Communicable Diseases; Consensus; Data; Diagnosis; Diagnostic; Dysuria; Economics; Enrollment; Fever; Future; Genitourinary system; High Prevalence; Impaired cognition; Incidence; Infection; Infection Control; Inflammation; Investigation; Kidney Failure; Laboratories; Left; Leukocytes; Literature; Logistic Regressions; Medical Surveillance; Modeling; Morbidity - disease rate; Nurses; Nursing Homes; Outcome; Outcome Measure; Pain; Pattern; Persons; Physicians; Population; Psyche structure; Publishing; Pyuria; ROC Curve; Randomized Controlled Trials; Recommendation; Renal Hypertension; Reporting; Research; Risk; Sample Size; Sepsis; Source; Standards of Weights and Measures; Surveys; Symptoms; Urinalysis; Urinary tract; Urinary tract infection; Urination; Urine; base; clinically relevant; cohort; day; experience; functional decline; improved; mortality; young adult

DESCRIPTION (provided by applicant): Urinary tract infection (UTI) is the most common indication for prescribing antibiotics in nursing home residents. To date, criteria for surveillance, diagnosis, and treatment of UTI in nursing home residents have been derived by consensus rather than empirical data. Lack of criteria from empirical evidence leaves nursing home practitioners with the common clinical dilemma of deciding whether nonspecific clinical changes (e.g., fever, altered mental status) are attributable to UTI and whether treatment will benefit clinical outcome. A key step to identifying who should receive antibiotics is to empirically determine diagnostic criteria, including both clinical and laboratory features. The long-term OBJECTIVE of this line of investigation is to identify the subset of nursing home residents with laboratory evidence of UTI (i.e., bacteriuria plus pyuria) in which antibiotic therapy reduces adverse outcomes (i.e., bacteremia, functional decline, death). The SPECIFIC AIM of this proposed research is to identify clinical features that are associated with laboratory evidence of UTI (bacteriuria [>100,000 colony forming units on urine culture] plus pyuria [>10 white blood cells on urinalysis]). Our a priori HYPOTHESIS is that specific clinical features (i.e., change in mental status, fever, change in voiding pattern) will be associated with laboratory evidence of UTI. This observational cohort study will be conducted at five New Haven area nursing homes with a sample size estimate of 493 residents. Persons aged 65 years or older will undergo baseline assessment upon enrollment and repeat assessment when suspected of having UTI. A logistic regression model will be used to determine bivariate and multivariable associations between clinical features and laboratory evidence of UTI. A ROC curve will be calculated from the final multivariable logistic regression model. Those clinical features independently associated with laboratory evidence of UTI will be combined with bacteriuria and pyuria to create an evidence-based definition of UTI. Identifying clinically relevant UTI in nursing home residents is a common dilemma with important functional, economic, and infection control implications. This study will create an evidence-based definition of UTI. Future studies will identify residents with UTI in whom antibiotic therapy improves clinical outcome.

描述（由申请人提供）：尿路感染（UTI）是在疗养院居民中开出抗生素的最常见指示。迄今为止，养老院居民中UTI的监视，诊断和治疗的标准是通过共识而不是经验数据得出的。缺乏经验证据的标准使疗养院的医生犯有决定非特异性临床变化（例如，发烧，精神状况改变）的常见临床困境，这归因于UTI以及治疗是否有益于临床结果。确定谁应该接受抗生素的关键步骤是凭经验确定诊断标准，包括临床和实验室特征。这项研究线的长期目标是确定具有UTI的实验室证据（即细菌和脓尿）的疗养院居民的子集，其中抗生素疗法减少了不良结果（即菌血症，功能下降，死亡，死亡）。这项拟议的研究的具体目的是鉴定与尿液实验室证据相关的临床特征（细菌[> 100,000个菌落形成尿培养上的菌落单位]加上脓尿[>尿液分析上的> 10个白细胞]）。我们的先验假设是，特定的临床特征（即精神状态的变化，发烧，无效模式变化）将与实验室的UTI证据有关。这项观察队列研究将在纽黑文地区的五个疗养院进行，样本量估计为493位居民。年龄在65岁以上的人在入学时会接受基线评估，并在涉嫌患有UTI时重复评估。逻辑回归模型将用于确定临床特征和UTI实验室证据之间的双变量和多变量关联。 ROC曲线将根据最终的多变量逻辑回归模型计算。这些与UTI实验室证据独立相关的临床特征将与细菌和脓尿相结合，以创建基于证据的UTI定义。在疗养院居民中识别临床相关的UTI是具有重要功能，经济和感染控制含义的常见困境。这项研究将创建一个基于证据的UTI定义。未来的研究将确定抗生素疗法改善临床结果的UTI居民。