Recognition Of Urinary Tract Infection Research Articles

Strategies for older people living in care homes to prevent urinary tract infection: the StOP UTI realist synthesis.

Urinary tract infection is the most diagnosed infection in older people. It accounts for more than 50% of antibiotic prescriptions in care homes and is a frequent reason for care home residents being hospitalised. This realist review developed and refined programme theories for preventing and recognising urinary tract infection, exploring what works, for whom and in what circumstances. The review used realist synthesis to explore existing literature on the detection and prevention of urinary tract infection, complemented by stakeholder consultation. It applies to the UK context, although other healthcare systems may identify synergies in our findings. Bibliographic databases searched included MEDLINE, CINAHL, EMBASE, Cochrane Library, Web of Science Core Collection (including the Social Sciences Citation Index), Sociological Abstracts, Bibliomap and National Institute for Health and Care Research Journals Library. Title and abstract screening were undertaken by two researchers independently of each other. Selection and assessment were based on relevance and rigour and cross-checked by a second researcher. Data extracted from the included studies were explored for explanations about how the interventions were considered to work (or not). Evidence tables were constructed to enable identification of patterns across studies that offered insight about the features of successful interventions. Programme theories were constructed through a four-stage process involving scoping workshops, examination of relevant extant theory, analysis and synthesis of primary research, teacher-learner interviews and a cross-system stakeholder event. A process of abductive and retroductive reasoning was used to construct context-mechanism-outcome configurations to inform programme theory. The scoping review and stakeholder engagement identified three theory areas that address the prevention and recognition of urinary tract infection and show what is needed to implement best practice. Nine context-mechanism-outcome configurations provided an explanation of how interventions to prevent and recognise urinary tract infection might work in care homes. These were (1) recognition of urinary tract infection is informed by skills in clinical reasoning, (2) decision-support tools enable a whole care team approach to communication, (3) active monitoring is recognised as a legitimate care routine, (4) hydration is recognised as a care priority for all residents, (5) systems are in place to drive action that helps residents to drink more, (6) good infection prevention practice is applied to indwelling urinary catheters, (7) proactive strategies are in place to prevent recurrent urinary tract infection, (8) care home leadership and culture fosters safe fundamental care and (9) developing knowledgeable care teams. We adapted our approach and work to online interactions with stakeholders and as a research team because of COVID-19. This also had an impact on bringing stakeholders together at a face-to-face event at the end of the project. Studies focusing on the prevention of urinary tract infection in care home settings were predominantly from the USA and Europe where the regulatory and funding systems for the long-term care of the elderly have some differences, particularly in the USA where national reporting plays a significant role in driving improvements in care. Care home staff have a vital role in the prevention and recognition of urinary tract infection, which can be enabled through integration and prioritisation within the systems and routines of care homes and delivery of person-centred care. Promoting fundamental care as a means of facilitating a holistic approach to prevention and recognition of urinary tract infection helps staff to recognise how they can contribute to antimicrobial stewardship and recognition of sepsis. Challenging assumptions made by staff about the presentation of urinary tract infection is complex and requires education that facilitates 'unlearning' and questioning of low-value practices. Programmes to prevent urinary tract infection need to be co-designed and supported through active and visible leadership by care home managers with support from specialist practitioners. We will focus on co-designing tools that facilitate implementation of our findings to ensure they fit with the care home context and address some of the challenges faced by care home leaders. This will underpin action at care home and system levels. Further research is needed to better understand the perspectives of residents and family carers, the effectiveness of non-pharmacological, pharmacological and specialist practitioner interventions and non-traditional approaches to training and educating the workforce in care home settings. This study is registered as PROSPERO CRD42020201782. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130396) and is published in full in Health Technology Assessment; Vol. 28, No. 68. See the NIHR Funding and Awards website for further award information.

Realist synthesis protocol for understanding which strategies are effective to prevent urinary tract infection in older people in care homes.

To identify and characterize strategies, which contribute to the prevention of urinary tract infection (UTI) in older people living in care homes. The realist synthesis has four iterative stages to (1) develop initial programme theory; (2) search for evidence; (3) test and refine theory supported by relevant evidence and (4) formulate recommendations. Data from research articles and other sources will be used to explore the connection between interventions and the context in which they are applied in order to understand the mechanisms, which influence the outcomes to prevent UTI. A scoping search of the literature and workshops with stakeholders will identify initial programme theories. These theories will be tested and refined through a systematic search for evidence relating to mechanisms that trigger prevention and recognition of UTI in older people in care homes. Interviews with key stakeholders will establish practical relevance of the theories and their potential for implementation. UTI is the most commonly diagnosed infection in care home residents. Evidence on the effectiveness of strategies to prevent UTI in long-term care facilities does not address the practicality of implementing these approaches in UK care homes. The realist synthesis is designed to examine this important gap in evidence. Our evidence-informed programme theory will help inform programmes to improve practice to reduce the incidence of UTI in older people living in care homes and related research. Patient and public involvement will be crucial to ensuring that our findings reach carers and the public. Involvement of patient and public representatives is embedded throughout the study to ensure it is underpinned by multiple perspectives of importance to care home residents. Our co-investigator representing patient and public involvement is a lay member of the team and will chair the Project Advisory Group, which has two additional lay members. This will help to ensure that our findings and resources reach carers and the public and represent their voice in our publications and presentations to professional and lay audiences.

Hospital clinical practice around urinalysis is an important opportunity for antimicrobial stewardship improvement activities.

To identify nurses' knowledge, perception and practice around urinalysis and asymptomatic bacteriuria (ASB) and to determine drivers of inappropriate urinalysis practice in an Australian hospital setting. Undertaken in eight geriatric wards over four hospitals, a questionnaire inviting voluntary, anonymous participation tested nursing staff knowledge on urinalysis, recognition of urinary tract infection (UTI) and perception of the utility of urinalysis as a routine test on all ward admissions. A retrospective one-month audit was performed on admissions to a 32-bed geriatric ward. 132 of 220 (60%) distributed surveys were completed. Performing urinalysis on all new admissions was identified as routine practice by 89%, and with indwelling catheter change by 35% of respondents. Over-three-quarters believed that routine urinalysis on admission was useful practice and up to one-third believed urinalysis abnormalities warranted antibiotic prescribing. Dark urine (57.6%), foamy urine (55.3%) and vaginal itch (34.5%) were identified as features suggestive of a UTI. In the ward audit, routine urinalysis on admission accounted for most urinalysis testing (59%, 24/41). Of occasions with clinical prompt, delirium accounted for 60% of urinalysis and urinary symptoms 33% however urine culture was undertaken on 53% of occasions. There was an overall lack of nursing knowledge regarding ASB, with a high perception that urinalysis abnormalities would be suspicious of a UTI irrespective of clinical findings and that routine urinalysis on ward admission was useful practice. In hospital settings, nursing stewardship can deliver strategies to increase knowledge, motivation and opportunity to improve appropriateness of UTI treatment and recognition of ASB.

The management of urinary tract infections in older patients within an urgent care out-of-hours setting.

This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.

G45 The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study: The Development of a Clinical Algorithm to Improve the Recognition of Urinary Tract Infection (UTI) in Pre-School Children Presenting to Primary Care

AimTo develop a clinical algorithm based on symptoms, signs and urine dipstick results to assist the identification of children who require urine sampling, antibiotic treatment and/or laboratory analysis.MethodsWe conducted a...

Using qualitative research to inform development of a diagnostic algorithm for UTI in children

Diagnostic and prognostic algorithms can help reduce clinical uncertainty. The selection of candidate symptoms and signs to be measured in case report forms (CRFs) for potential inclusion in diagnostic algorithms needs to be comprehensive, clearly formulated and relevant for end users. To investigate whether qualitative methods could assist in designing CRFs in research developing diagnostic algorithms. Specifically, the study sought to establish whether qualitative methods could have assisted in designing the CRF for the Health Technology Association funded Diagnosis of Urinary Tract infection in Young children (DUTY) study, which will develop a diagnostic algorithm to improve recognition of urinary tract infection (UTI) in children aged <5 years presenting acutely unwell to primary care. Qualitative methods were applied using semi-structured interviews of 30 UK doctors and nurses working with young children in primary care and a Children's Emergency Department. We elicited features that clinicians believed useful in diagnosing UTI and compared these for presence or absence and terminology with the DUTY CRF. Despite much agreement between clinicians' accounts and the DUTY CRFs, we identified a small number of potentially important symptoms and signs not included in the CRF and some included items that could have been reworded to improve understanding and final data analysis. This study uniquely demonstrates the role of qualitative methods in the design and content of CRFs used for developing diagnostic (and prognostic) algorithms. Research groups developing such algorithms should consider using qualitative methods to inform the selection and wording of candidate symptoms and signs.

Management of urinary tract infection

Summary Urinary tract infection (UTI) is an important cause of febrile illness in children and its recognition and subsequent management should be carried out effectively if we are to try and prevent the potential long-term sequelae of renal scarring, hypertension and renal failure. The steps in diagnosis include recognition of UTI as a possible cause of illness, and collection of an adequate urine specimen to enable the diagnosis to be confirmed. Antibiotic treatment should be started promptly, particularly in young children, and follow-up investigations, appropriate to the age of the child, should then be undertaken. Investigations are geared towards identifying renal parenchymal damage and renal tract abnormalities predisposing to UTI and pyelonephritis. Children found to have renal scarring require follow-up with respect to blood pressure and possible renal failure, if scarring is bilateral.

Clinical Pyelonephritis and Focal Renal Scarring: A Selected Review of Pathogenesis, Prevention, and Prognosis

This article considers the pathogenesis of acute pyelonephritis; determinants of focal renal scarring; prevention of renal damage by early recognition of urinary tract infection in childhood; and renal growth patterns in kidneys damaged during early childhood.

The recognition of urinary tract infections in office-based pediatric practice. Need for a systematic approach to the use of urine cultures in ambulatory care.

The recognition of urinary tract infections in office-based pediatric practice. Need for a systematic approach to the use of urine cultures in ambulatory care.

RECALCITRANT URINARY-TRACT INFECTIONS. TREATMENT WITH INTRAVENOUS OXYTETRACYCLINE HYDROCHLORIDE.

MORE FREQUENT recognition of urinary-tract infections has occurred in recent years. Unsuspected serious kidney infections have often been discovered only when severe renal damage was found at autopsy. 1 The frequency of cures of severe genitourinary-tract infections has not paralleled the increasing numbers of antibacterial agents available for treatment. The experience of most clinicians and microbiologists indicates that the causative agents of such infections are resistant to a larger spectrum of antibacterial drugs. 2 It is neither surprising nor uncommon to encounter strains of Pseudomonas, Proteus , and Aerobacter which are resistant to all antibiotics tested by the disk sensitivity method. When such a situation arises, the availability of an antimicrobial agent which could safely reach bactericidal levels in the patient, even though a sensitivity test showed a significant degree of resistance, would be highly desirable. Intravenous oxytetracycline hydrochloride (Terramycin) appears to possess some of the desirable characteristics for such therapy.

RELATIONSHIP OF THE GRIESS NITRITE TEST TO BACTERIAL CULTURE IN THE DIAGNOSIS OF URINARY TRACT INFECTION

Article1 January 1961RELATIONSHIP OF THE GRIESS NITRITE TEST TO BACTERIAL CULTURE IN THE DIAGNOSIS OF URINARY TRACT INFECTIONLEON G. SMITH, M.D., WALTER R. THAYER, M.D., ELLI M. MALTA, JOHN P. UTZ, M.D.LEON G. SMITH, M.D.Search for more papers by this author, WALTER R. THAYER, M.D.Search for more papers by this author, ELLI M. MALTASearch for more papers by this author, JOHN P. UTZ, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-54-1-66 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptInterest has been renewed periodically in the Griess nitrite reaction as a means of detecting bacterial infection in urine.1-4 Although it was originally employed as a test of bacterial contamination of water,5 its application as an indicator of bacteriuria was suggested by the finding that most of the bacterial species which cause urinary tract infection reduce nitrate to nitrite.In vitro studies by Kahler and Guze6have revealed that sodium nitrite in concentrations of as little as 0.1 μg. per milliliter gives a positive test. However, considerable periods of time were required for nitrate reduction by certain strains of bacteria....Bibliography1. WeltmannHaslinger OK: Die Nitritreaktion im Harn als der Harninfektion, Ztschr. f. urol. Chir. 18: 73-85, 1925. Google Scholar2. VaradySzanto JG: Untersuchungen über den Nitritgehalt des Speichels des Magensaftes und des Harnes, Klin. Wchnschr. 19: 200-203 (Mar. 2) 1940. CrossrefGoogle Scholar3. BechgaardJansen PKF: Nitritreaktion ved Urnvejsinfektion, Nord. med. 20: 2134-2136 (Dec. 4) 1943. Google Scholar4. Schaus R: Griess' nitrite test in diagnosis of urinary infection, J. A. M. A. 161: 528-529 (June 9) 1956. CrossrefMedlineGoogle Scholar5. Griess P: Bemerkungen zur Abhandlung der H. H. Weselsky und Benedickt: "Ueber einige Azoverbindungen," Berichteder deutsch. chem. gesllsch. 12: 426-428 (Mar.) 1879. CrossrefGoogle Scholar6. KahlerGuze RLLB: Evaluation of the Griess nitrite test as a method for the recognition of urinary tract infection, J. Lab. Clin. Med. 49: 934-937 (June) 1957. MedlineGoogle Scholar7. Feigl F: Spot tests in inorganic analysis, 5th Ed., 1958, Elsevier Publishing Company, Amsterdam, p. 330. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Bethesda, Maryland*Received for publication April 25, 1960.From the Infectious Disease Service, Laboratory of Clinical Investigation, the National Institute of Allergy and Infectious Diseases; from the Employee Health Service; and from the Clinical Pathology Department, Clinical Center, National Institutes of Health, U. S. Public Health Service, Department of Health, Education and Welfare, Bethesda, Maryland.Requests for reprints should be addressed to John P. Utz, M.D., Chief, Infectious Disease Service, Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 14, Maryland.*All examinations of urine except the Griess tests were performed by the Clinical Pathology staff of the Clinical Center, National Institutes of Health, Bethesda, Maryland. All studies were performed during 1958 and, with infrequent exception, the large series of specimens were consecutive accessions to the laboratory. 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Evaluation of the Griess nitrite test as a method for the recognition of urinary tract infection.

Abstract The reliability of the Griess nitrite test in the recognition of urinary tract infection has been evaluated, employing several micro-organisms known to reduce nitrate. Although the Griess reaction is able to detect 0.1 μg of sodium nitrite per milliliter, it appears to be of limited value as a screening or diagnostic test for the presence of urinary infection. The inability of some pathogenic bacteria to reduce nitrate, the variable rate of the reaction with other organisms, and the relatively large numbers of microorganisms required to produce detectable nitrite detract from the value of this test as a practical clinical procedure.