Detection Of Urinary Tract Infection Research Articles

A new point-of-care test for the rapid detection of urinary tract infections

Urinary tract infections (UTIs) are among the most common infections in all age groups. Fast and accurate diagnosis is essential to ensure a timely and effective therapy. Alongside with reference culture-based methods, several point-of-care tests (POCTs) for early detection of UTIs have been developed, but they have not been significantly implemented in current clinical practice. The Micro Biological Survey (MBS) POCT is a simple test developed by MBS Diagnostics Ltd. (London, UK) for the detection and management of UTIs. The present study has been undertaken to investigate the potentials and limits of the MBS POCT. A total of 349 patients were enrolled in two open-label, monocentric, non-interventional clinical trials in collaboration with an Emergency Medicine department and the outpatient clinic of two hospitals in Rome. Results of urine analysis using the MBS POCT were compared with those of the routine culture-based tests for UTI diagnosis performed by the hospital laboratory. The MBS POCT provided fast results revealing high bacterial count UTIs (≥ 105 CFU/ml) with 97% accuracy, 92% sensitivity, 100% specificity, 99% PPV, and 96% NPV within a 5-h analytical time threshold.

The Effectiveness of Dipstick for the Detection of Urinary Tract Infection.

Background The balance between the choices of UTI diagnostic tools in most primary care settings has been settled for by the more rapid, less labour-intensive dipstick. This study aimed to evaluate the effectiveness of dipstick for diagnosing UTI. Method A total of 429 urine samples were collected from patients suspected of UTI; cultured on cysteine-lactose-electrolyte-deficient (CLED) agar, blood agar, and MacConkey agar; and incubated at 37°C overnight. Urine cultures with bacteria count ≥105 cfu/ml were classified as “positive” for UTI. A dipstick was used to screen for the production of nitrite (NIT) and leucocyte esterase (LE), following the manufacturer's instructions. Biochemical reactions of nitrite and leucocyte esterase > “trace” were classified as “positive.” A quantitative urine culture was used as the gold standard. Results The highest sensitivity value and negative predictive value were recorded for the combined “NIT+ or LE+” dipstick results. The highest specificity value, positive predictive value, positive likelihood ratio, and negative likelihood ratio were recorded for “nitrite-positive and leucocyte esterase-positive” results. Combined “nitrite-positive or leucocyte-positive” result was relatively the best indicator for accurate dipstick diagnosis, with AUC = 0.7242. Cohen's kappa values between dipstick diagnosis and quantitative culture were <0.6. Conclusion Combined performance of nitrite and leucocyte esterase results appeared better than the solo performance of nitrite and leucocyte esterase. However, little confidence should be placed on dipstick diagnosis; hence, request for quantity culture should be encouraged in the primary healthcare settings.

Screening for urinary tract colonisation prior to corticosteroid administration in acute multiple sclerosis relapses: Validation of an updated algorithm

IntroductionTo evaluate an updated algorithm in the detection of urinary tract infection (UTI) prior to high-dose corticosteroid treatment in acute relapses in multiple sclerosis (MS). This updated algorithm aimed to decrease the unnecessary use of antibiotics, whilst maintaining accuracy and safety. MethodsProspective cohort study of 471 consecutive patients with MS relapses in a hospital-based outpatient acute relapse clinic. 172 patients met exclusion criteria, leaving 299 patients for analysis. Patients underwent urine dipstick and were treated for UTI if 2 or more of: nitrites, leukocyte esterase and cloudy urine were positive. Patients with confirmed acute MS relapse were treated with high dose intravenous or oral methylprednisolone. ResultsSignificant bacteriuria (>105 colony forming units/mL) was present in 33 (11%, 95% CI 8-15) patients. The algorithm sensitivity and specificity was 24% and 94% respectively; the negative predictive value was 91%. The overall accuracy of the algorithm was 87%. No adverse sequelae were identified in 25 patients who received high dose methylprednisolone in the presence of an untreated UTI. ConclusionWith an improved specificity, this updated algorithm addresses previous issues concerning the unnecessary prescription of antibiotics, whilst improving accuracy and maintaining safety.

Using artificial intelligence to reduce diagnostic workload without compromising detection of urinary tract infections

BackgroundA substantial proportion of microbiological screening in diagnostic laboratories is due to suspected urinary tract infections (UTIs), yet approximately two thirds of urine samples typically yield negative culture results. By reducing the number of query samples to be cultured and enabling diagnostic services to concentrate on those in which there are true microbial infections, a significant improvement in efficiency of the service is possible.MethodologyScreening process for urine samples prior to culture was modelled in a single clinical microbiology laboratory covering three hospitals and community services across Bristol and Bath, UK. Retrospective analysis of all urine microscopy, culture, and sensitivity reports over one year was used to compare two methods of classification: a heuristic model using a combination of white blood cell count and bacterial count, and a machine learning approach testing three algorithms (Random Forest, Neural Network, Extreme Gradient Boosting) whilst factoring in independent variables including demographics, historical urine culture results, and clinical details provided with the specimen.ResultsA total of 212,554 urine reports were analysed. Initial findings demonstrated the potential for using machine learning algorithms, which outperformed the heuristic model in terms of relative workload reduction achieved at a classification sensitivity > 95%. Upon further analysis of classification sensitivity of subpopulations, we concluded that samples from pregnant patients and children (age 11 or younger) require independent evaluation. First the removal of pregnant patients and children from the classification process was investigated but this diminished the workload reduction achieved. The optimal solution was found to be three Extreme Gradient Boosting algorithms, trained independently for the classification of pregnant patients, children, and then all other patients. When combined, this system granted a relative workload reduction of 41% and a sensitivity of 95% for each of the stratified patient groups.ConclusionBased on the considerable time and cost savings achieved, without compromising the diagnostic performance, the heuristic model was successfully implemented in routine clinical practice in the diagnostic laboratory at Severn Pathology, Bristol. Our work shows the potential application of supervised machine learning models in improving service efficiency at a time when demand often surpasses resources of public healthcare providers.

Clinico-Laboratory Profile and Drug Sensitivity Pattern in Urinary Tract Infection of Children in a Tertiary Care Hospital

Background: Urinary tract infection (UTI) is common in children. About 7% girls and 2% of boys suffer from symptomatic, culture positive UTI by 6 years of age. These children present with poor feeding, irritability, vomiting, fever, abdominal pain or failure to thrive. Now a days antibiotic resistance is a global problem which hampers appropriate treatment of urinary tract infection in children. This study was done to see clinical profile, common pathogens and their drug sensitivity pattern in UTI.&#x0D; Methodology: It is a prospective study conducted in Delta Medical College &amp; Hospital, Dhaka. All cases collected from outdoor patient or inpatient who were clinically suspected as UTI were enrolled in this study from January 2015 to July 2017. Total 200 cases were included. History was taken properly. Diagnosis of UTI was confirmed by urinalysis and culture sensitivity (C/S). All informations were recorded in preformed data sheet.&#x0D; Results: Usual presentations of UTI were fever, abdominal pain, vomiting, constipation, urinary complaints, poor feeding, labial adhesion, jaundice, excessive straining. Out of 200 cases 168 were culture positive. Group III age group (&gt; 1year- 5 year) showed higher rate of UTI. UP to one year of age males were more affected than female and beyond one-year females were more affected than male. Most common isolated uropathogen was Escherichia coli. Most sensitive drugs for the pathogen were Imipenem and meropenem (89.39%) - Injectable form and nitrofurantoin (73.48 %)- Oral form.&#x0D; Conclusion: Presentation of UTI in case of young infant is different from older children. Clinical suspicion is important for early detection of UTI. Before starting antimicrobial therapy, we must do urinalysis and culture sensitive test to prevent recurrent UTI.&#x0D; Bangladesh J Child Health 2019; VOL 43 (2) :74-79

Evaluation of the efficiency of URO-QUICKTM System in the Detection of Urinary Tract Infections and use of Fluorescence In-Situ Hybridization (FISH) In Detection of Escherichia coli in Urine

Evaluation of the efficiency of URO-QUICKTM System in the Detection of Urinary Tract Infections and use of Fluorescence In-Situ Hybridization (FISH) In Detection of Escherichia coli in Urine

Clinical application in the rapid diagnosis of urinary tract infection

Objective To explore the value of UF-5000 urinary sediment analyzer in assistant examination of urinary tract infections by comparing the results of bacteria and white blood cells for UF-5000 with those of routine laboratory methods. Methods A total of 1 021 clean mid-stage urine samples suspected urinary tract infection were collected from the inpatients and outpatients of the Guangdong Provincial People′s Hospital from October to December 2017. All specimens were detected by UF-5000 to evaluate the repeatability, linearity, carrying contamination rate, stability and efficiency of review flag by the instrument. Urine bacterial culture and clinical diagnosis were used as reference standards to calculate the coincidence rate of bacterial test results with purified bacteria, coincidence rate with bacterial culture, and agreement rate with cultured colonies. The urinary fungal culture and clinical diagnosis were used as reference standards to calculate the coincidence rate, sensitivity and specificity of the fungal test. Based on the results of bacterial culture and clinical diagnosis, UF-5000 was used to detect the efficacy of white blood cells and bacteria for the diagnosis of UTI. The results of UF-5000 detection, the results of urinary dry chemistry analyzer UC-3500, and the results of bacterial smear microscopy were compared with the results of urinary bacterial culture to determine the sensitivity, specificity and sensitivity of each method, and the coincidence rate of with the culture method. Statistical analysis was performed using variance analysis, Wilcoxon rank sum test, coincidence rate test (Kappa test), and receiver operating characteristic curve (ROC curve). Results UF-5000 was used to detect bacteria and white blood cells, UC-3500 was used to detect neutrophil esterase and nitrite with good repeatability, which met the EP5-A requirements; the linear relationship between bacteria was very good in the range of 0-10 000/ml, R=0.999; the contamination rate of UF-5000 was 0.00% for bacteria, 0.01% for white blood cells. The rate of UC-3500 was qualified; the bacteria was stable for 2 hours at room temperature and 6 hours at 4 ℃, and the white blood cells were stable for 4 hours at room temperature and 4 hours at 4 ℃. Compared with UF-1000i, the review flag rate of UF-5000 reduced about 77.8%. The coincidence rate of detection and purification of UF-5000 bacteria was 100.0% (16/16) , that of Gram-negative bacteria (G-) was 94.0% (110/117) , that of Gram-positive bacteria (G+) was 82.2%(37/45).The agreement rate of compared with bacterial colonies was 95.1%(216/227), and that of fungi culture was 77.1% (749/972), that of sensitivity was 81.9%(118/144), and that of specificity was 76.2%(631/828). UF-5000, UC-3500, and bacterial smear microscopy showed that the ability of bacterial infection of urinary tract was compared with the results of traditional bacterial culture. The UF-5000 urinary tract infection flag (UTI) had the highest agreement rate, reaching 84.1% (180/214). The sensitivity was 70.3% (52/74), the specificity was 91.4% (128/140); the coincidence rate of UC-3500 was 73.8% (158/214), the sensitivity was 25.7% (19/74), and the specificity was 99.3% (139/140); the consistency of bacterial smear microscopy was 66.4% (142/214), the sensitivity was 82.4% (61/74), and the specificity was 57.9% (81/140). Conclusion The total number of bacteria and white blood cell counted by UF-5000, the flag of bacterial and the UTI information, have partial clinical significance in the rapid detection of urinary tract infection. Key words: Urinary tract infection; Bacteria

A micro-Raman and chemometric study of urinary tract infection-causing bacterial pathogens in mixed cultures

Detection of urinary tract infection (UTI)-causing bacteria uses conventional time-consuming microbiological techniques. The current need is to use a fast and reliable method of bacterial identification. In order to unambiguously distinguish the UTI-causing five bacterial species used in the current study, micro-Raman spectra were obtained from a home-assembled micro-Raman system and analyzed by multivariate statistical techniques such as principal component analysis (PCA), partial least square-discriminate analysis (PLS-DA), and support vector machine (SVM). Also, the micro-Raman spectra recorded from samples containing two and three bacterial species were tested and validated against the aforementioned calibration models using PLS-DA and SVM. The prediction accuracies of up to 73 and 89% were achieved with PLS-DA and SVM, respectively. Taken together, the present study depicts the capturing of unique micro-Raman spectral features manifesting from the biochemical content of each bacterium. Also, micro-Raman spectroscopy combined with multivariate data analysis can therefore be a reliable and faster technique for the diagnosis of UTI-causing bacteria. Graphical Abstract.

Evaluation of Urine Procalcitonin, Interleukin-6, Heparin Binding Protein, Leukocyturia, and Bacteriuria for Early Detecting Urinary Tract Infection

Urinary Tract Infection (UTI) is a common infectious disease. Urine culture as a gold standard is less practical and time- consuming. Examination of urine dipstick and microscopic is less accurate. Procalcitonin (PCT), IL-6 and Heparin Binding Protein (HBP) have known increase after infection, which potentially used for early detection of UTI. The aim of this study was to determine the diagnostic performance of urine IL-6, HBP, PCT, leukocyturia and bacteriuria level as biomarkers of UTI. The study was conducted on 51 UTI patients with positive urine culture, 16 UTI patients with negative urine culture, and 16 healthy control. Urine IL-6, HBP, and PCT level were determined using ELISA. Leukocyturia and bacteriuria were measured using automated flowcytometry and fluorescent dye analyzers. The gold standard for UTI diagnosis was urine culture. The sensitivity and specificity of urine PCT, IL-6, HBP, leukocyturia and bacteriuria were 60.78% and 65.62%; 72.55% and 56.25%; 96.07% and 50.00%; 80.39% and 78.12%; 80.39% and 59.09% respectively. The AUC of urine PCT, IL-6, HBP, leukocyturia and bacteriuria were 0.600; 0.605; 0.666; 0.877 and 0.830 respectively. For combinations of two biomarkers, the best sensitivity and specificity was demonstrated by urine PCT and leukocyturia.

Analysis of bacterial urinary tract infection among pregnant women in tertiary hospital Katsina

Urinary Tract Infection (UTI) is an infection caused by the presence and replication of microorganisms in the urinary tract. The aim of this study is to evaluate the distribution of UTI pathogens associated with pregnant women attending Federal Medical Center, Katsina. The research was a prospective study conducted among 126 antenatal attendees. Urine microscopy and culture technique were conducted for each participant. Statistical analysis of data was done using Graph Pad Prism Statistical software. Twenty-five out of the participants had asymptomatic bacteriuria giving a prevalence of 19.8%. However age (P=0.66), educational status (P=0.19) and settlement (P=0.91) are not statistically significant. While tribe and gestational age (trimester) are found to be statistically significant (P = 0.02). Staphylococcus aureus is found to be the most prevalent organism (40%), followed by coagulase negative Staphylococcus (32%) and the least is Eschericia coli (4%). However, comparison between Hausa and Yoruba had shown that Hausa tribe has more chance of infected with Asymptomic bacteriuria during pregnancy and high risk than Yoruba tribe! Therefore, UTI has the potentiality to pose serious life threatening consequences when left untreated. This is more likely to be the case where access to or availability of timely and appropriate medical intervention due to inadequate numbers of health care providers.It is therefore, recommended that pregnant women should be subjected for urine laboratory screening for the detection of UTI during the first trimester and treatment follows immediately for the positive results. Key Word : Bacteriuria, Infection, Pregnancy, and Urine culture.

Quantum dot modified interface for electrochemical immunosensing of procalcitonin for the detection of urinary tract infection

An electrochemical immunoelectrode is fabricated and investigated for quantification of the Procalcitonin (PCT), a protein over expressed in urinary tract infection (UTI). The sensor electrode is prepared by self assembling the conjugate of Zinc sulfide capped Cadmium selenide quantum dots (QD) and PCT specific monoclonal antibody (MAb) over the indium-tin-oxide (ITO) coated glass substrate. The presence of QD in the conjugate is found to provide more electroactive surface area and improved electron transfer kinetics and diffusion coefficient to the immunoelectrode. The electrochemical characteristics of this immunoelectrode towards synthetic PCT sample reveal specificity among the pool of various analytes. The sensing characteristics reveal that the sensor can potentially detect PCT over a concentration of 0.21 ng/mL which is above pathological range in healthy person. However, in absence of QD, the detection range lies in between 0.1 μg/mL to 10 μg/mL, which is far above the expressed concentration of PCT in UTI. Under optimal conditions, the QD based immunoelectrode exhibited good calibration range from 1 ng/ml to 10 μg/mL.

2171. Comparing Surveillance Definitions for Noncatheter-Associated Urinary Tract Infections

BackgroundPatient sharing between hospitals and long-term care facilities (LTCF) is widespread. However, surveillance criteria for noncatheter associated urinary tract infection (UTI) vary by healthcare setting. Consequently, patients with identical features of UTI may meet criteria in LTCF but not in hospitals. A common definition that spans hospitals and LTCF may inform UTI surveillance efforts across healthcare facilities.MethodsWe performed a cohort analysis of all suspected UTI cases in women ≥65 years from 21 LTCF enrolled in a clinical trial evaluating cranberry capsules to reduce bacteriuria plus pyuria from August 2012 to October 2015. We applied 2017 hospital National Healthcare Safety Network (NSHN), 2012 LTCF NSHN, and proposed criteria (Figure 1) to all suspected UTI cases. Proposed criteria were derived a priori. Differences in the correlated proportions of UTI detected per criteria were assessed using McNemar’s test.ResultsOf 350 suspected UTI cases, LTCF NSHN criteria detected more UTI (22/350, 6.3%) compared with hospital NHSN (15/350, 4.3%; P = 0.04) and proposed (15/350, 4.3%; P = 0.02) criteria (Table 1). Half (11/22) of LTCF NHSN UTI included ≥102 CFU/mL of organisms from a catheterized urine as the microbiological criterion. Four UTI meeting LTCF NHSN or proposed criteria did not meet the hospital NHSN criteria because fever is only a listed clinical feature for patients ≤65 years.Table 1.UTI Detection by Surveillance Criteria.Criteria P valueLTCF NHSN Hospital NHSN PresentAbsentPresent132Absent93260.04 LTCF NHSN Proposed PresentAbsentPresent150Absent73280.02 ConclusionCurrent hospital and LTCF NHSN criteria both have limitations. The hospital NHSN criteria exclude fever in older adults as a clinical feature. The LTCF NHSN criteria include insensitive microbiological criteria. Our proposed surveillance criteria address these limitations and may be generalizable to both hospitals and LTCF.Disclosures M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee.

Evaluation of the Relationship Between Clinical Symptoms and Isolation of Fastidious Bacteria in Urine Samples of Elderly Females

Background: Although urinary tract infections (UTIs) are one of the common infections, especially among elderly, the gold standard diagnostic method is still bacterial culture. Since large percentages of urine culture are negative, it seems that specialists should pay more attention to other bacteria, such as fastidious bacteria. The aim of this study was to use the method of fastidious bacteria isolation for urine samples of elderly females with negative results for conventional culture. Methods: This study was conducted at Imam Khomeini hospital and fastidious bacteria from urine samples of 1075 females older than 60 years were isolated and identified. Developing changes in culture media and incubation conditions and gas levels led to isolation of fastidious bacteria. Results: After overnight aerobic culturing of 1075 urine samples, 383 cases had positive, 99 cases had low counting, 159 cases had mixed, and 434 cases had negative test results. Among 434 negative cases obtained from these methods, and using fastidious bacteria in this study, 147 subjects had Fastidious bacterial, more than 50% of which was associated with infection symptoms, indicating a significant difference. Conclusions: For the isolation and detection of urinary tract infections in elderly female patients with negative aerobic and night culture results, especially if it was associated with the presence of symptoms, culturing the samples in additional and selective environments with changes in the incubation conditions is necessary in order to isolate bacteria.

Completed loop audit – minimising the number of on-the-day cancellations for urological procedures through improved detection of urinary tract infection pre-operatively

Completed loop audit – minimising the number of on-the-day cancellations for urological procedures through improved detection of urinary tract infection pre-operatively

Portable Bladder Ultrasound Reduces Incidence of Urinary Tract Infection and Shortens Hospital Length of Stay in Patients With Acute Ischemic Stroke.

Background:Urinary tract infection (UTI) during acute ischemic stroke is associated with a longer hospital length of stay and unfavorable functional outcomes.Objective:We investigated the benefits of portable bladder ultrasound (PBU) scanning during acute ischemic stroke.Methods:We retrospectively reviewed patients with acute ischemic stroke from January 2011 to February 2017. Patients were divided into group 1 (PBU not available) and group 2 (PBU available), before or after the split date, April 9, 2014. Portable bladder ultrasound scanning was conducted by nurses to measure postvoid residual urine volume in patients with impaired consciousness and/or dependent ambulation.Results:In total, 1928 patients were enrolled, of whom 109 (5.7%) had UTI and 901 (46.7%) experienced unfavorable outcomes (modified Rankin scale score ≥ 3). Multivariate analysis revealed that factors that influenced UTI were age of 75 years or older, female gender, initial total National Institutes of Health Stroke Scale (NIHSS) score of 5 or higher, initial NIHSS conscious score of 1 or higher, initial NIHSS leg score of 2 or higher, and urinary catheterization. Factors influencing unfavorable outcomes were similar to those influencing UTI but further comprised UTI. C-statistic for UTI detection was 0.864 for model fitting, including significant factors in logistic regression. Compared with group 1, group 2 had a higher incidence of urinary catheterization (13.1% vs 8.2%), a lower incidence of UTI (4.0% vs 6.9%), and a shorter length of stay (11.9 vs 13.6 days).Conclusions:Portable bladder ultrasound scanning reduced the incidence of UTI and shortened length of stay. We suggest routine PBU procedures for patients with acute ischemic stroke who fulfill the AGN3 criteria for a high risk of UTI.

Platelet indices in children with urinary tract infection

Background: Urinary tract infection is one of the most common infection in children and may lead to serious morbidity like chronic pyelonephritis and renal scarring. Our hypothesis is that alteration of the platelet morphology can be a reliable index for early diagnosis and management of UTI without waiting for urine culture results. We try to demonstrate a link between the platelet indices and the type of organism, whether gram positive or gram negative to allow proper selection of the antibiotic regimen.Methods: It is a retrospective case control study where 35 urine culture proven cases and 35 cases of non UTI cases was taken as control. Children with haematological diseases affecting platelet were excluded. Platelet indices were taken including for MPV, PDW and platelet count and statistically analysed.Results: MPV and PDW were higher in patient with culture proven especially with gram positive organism.Conclusions: Although urine culture is considered as golden standard for diagnosis of urinary culture, it is time consuming. But early diagnosis can prevent renal parenchymal complications. Hence, we tried to find out other early, easy and sensitive method for detection of urinary tract infections in children. Platelet parameters (thrombocytosis, mean platelet volume, platelet distribution width) is available in analyser report of any complete blood count with no added value. It was also found that gram positive organism has higher mean platelet volume and platelet distribution width as compared to gram negative organism.

Diagnostic accuracy of urinary biomarkers in infants younger than 3 months with urinary tract infection.

PurposeThe aim of this study was to evaluate the diagnostic accuracy of urinary biomarkers, such as neutrophil gelatinase-associated lipocalin (uNGAL) and β-2 microglobulin (uB2MG), in early detection of urinary tract infection (UTI) in infants aged <3 months with fever.MethodsA total of 422 infants aged <3 months (male:female=267:155; mean age, 56.4 days), who were admitted for fever, were retrospectively included in this study. We compared uNGAL and uB2MG between the UTI and non-UTI groups at the time of admission. The sensitivity, specificity, accuracy, and area under the curve (AUC) of uNGAL and uB2MG for use in diagnosing UTI were assessed.ResultsAmong 422 patients, 102 (24.2%) were diagnosed with UTI. Levels of uNGAL were higher in the UTI group than in the non-UTI group (366.6 ng/mL vs. 26.9 ng/mL, P<0.001). Levels of uB2MG were not different between the 2 groups. Multivariate analysis revealed that uNGAL was an independent predictive factor for UTI (P=0.033). The sensitivity, specificity, and accuracy were 90.2%, 92.5%, and 91.9% for uNGAL, and 48.0%, 43.8%, and 44.8% for uB2MG, respectively. AUC of uNGAL was 0.942 and that of uB2MG was 0.407.ConclusionAccuracy of uNGAL in the diagnosis of UTI is high in febrile infants aged <3 months. uNGAL can help in the early diagnosis and treatment of UTI in infants.

Utilization of Antibiotics in Long-Term Care Facilities in British Columbia, Canada

BackgroundAntibiotic use is highly prevalent in long-term care facilities (LTCFs); a resident's annual exposure to at least 1 course of antibiotic is approximately 50% to 80%. The objective of this study was to understand the extent of antibiotic use in the population of residents in British Columbia's (BC) LTCFs from 2007 to 2014. MethodsAntibiotic prescription data for LTCF residents was extracted from the central prescription database and linked to the physician billing plan to obtain antibiotic indication. Total defined daily dose (DDD) per 1000 residents per day was calculated. ResultsOur database had 381 LTCFs with an average of nearly 24,694 residents annually and 419,036 antibiotic prescriptions. Antibiotic utilization did not change dramatically between 2007 and 2014, ranging from 39.2 in 2007 to 35.2 DDD per 1000 residents per day in 2014. Although usage of most antibiotics declined, use of moxifloxacin, amoxicillin-clavulanate, doxycycline, and amoxicillin increased significantly. The indication most frequently linked to prescription was urinary tract infection (6.58 DDD per 1000 residents per day), with nitrofurantoin, ciprofloxacin, and trimethoprim/sulfamethoxazole being the most commonly prescribed agents. This was followed closely by prescriptions for respiratory infections (5.34 DDD per 1000 residents per day), with moxifloxacin being the most commonly prescribed antibiotic, primarily for upper respiratory tract infection (URTI), whereas doxycycline is used commonly for lower respiratory tract infection. Duration of antibiotic therapy in LTCF residents has decreased significantly from 9.29 days to 7.3 days per prescription in 2014. ConclusionAntibiotic use in LTCFs is high relative to the general population. Our study underscores that stewardship in LTCFs should continue to focus on length of treatment, appropriate detection of urinary tract infections, and avoidance of treating URTIs with antibiotics.

Diagnostic strategies for urinary tract infections in French general practice

ObjectivesWe aimed to describe the diagnostic management procedures for detection of urinary tract infections in general practice and their correlated factors. Patients and methodsWe analyzed data from the ECOGEN study on urinary tract infections, collected in France between November 2011 and April 2012. This national cross-sectional study was carried out in general practices. Data was coded according to the International Classification of Primary Care. ResultsA total of 340 consultations or home visits were held for urinary tract infections. The five most frequent diagnostic procedures were (in descending order) clinical examination (67.6%), urine cytobacteriological examination (UCBE) (47.9%), urine dipstick test (15.6%), blood test (8.5%), and imaging (6.5%). No urine dipstick test or UCBE was performed in 43% of cases. Factors correlated with diagnostic procedures were age and gender of patients, annual number of consultations held by family physicians, and duration of consultation. ConclusionFamily physicians did not comply with guidelines on diagnostic management for detection of urinary tract infections. We hypothesized that this non-compliance could be due to the family physicians’ environment and characteristics, and to clinical practice guidelines.

Diaper-Embedded Urinary Tract Infection Monitoring Sensor Module Powered by Urine-Activated Batteries

Urinary tract infection (UTI) is one of the most common infections in humans. UTI is easily treatable using antibiotics if identified in early stage. However, without early identification and treatment, UTI can be a major source of serious complications in geriatric patients, in particular, those suffering from neurodegenerative diseases. Also, for infants who have difficulty in describing their symptoms, UTI may lead to serious development of the disease making early identification of UTI crucial. In this paper, we present a diaper-embedded, wireless, self-powered, and autonomous UTI monitoring sensor module that allows an early detection of UTI with minimal effort. The sensor module consists of a paper-based colorimetric nitrite sensor, urine-activated batteries, a boost dc-dc converter, a low-power sensor interface utilizing pulse width modulation, and a Bluetooth low energy module for wireless transmission. Experimental results show a better detection of nitrite, a surrogate of UTI, than that of conventional dipstick testing. The proposed sensor module achieves a sensitivity of 1.35 ms/(mg/L) and a detection limit of 4 mg/L for nitrite.