Test For Urinary Tract Infection Research Articles

Evaluation of Routine Urine Analysis in Diagnosing Urinary Tract Infection among Pediatric Population: A Validation Study

Background: Urinary tract infection (UTI) stands out as one of the most common bacterial infections affecting children below the age of five. A valid diagnostic test for UTI is of utmost importance for avoiding bacterial resistance.Objectives: To assess the diagnostic efficacy of routine urine examinations in detecting urinary tract infections in pediatric patients, employing urine culture as the reference standardMaterial and Methods: This diagnostic study was conducted at leady reading hospital, Peshawar. The study employed a non-probability consecutive sampling technique and included 130 children between the ages of 1 and 5 years, regardless of gender, who exhibited symptoms suggestive of urinary tract infections. Exclusion criteria comprised children who had taken antibiotics within the past 48 hours, those with congenital renal anomalies such as renal or renal tumors, renal tract obstruction, and acute renal failure. All participants underwent urine regular examination and urine culture. Sensitivities, specificities, and accuracy were calculated, and the data was further stratified based on gender and age.Results: The mean age of the participants was 2.646±1.32 years. The males were predominant (n-86, 66.2%). The urine examination demonstrated a specificity of 90.91% and a sensitivity of 58.06% in detecting urinary tract infections. A statistically significant difference was observed when comparing the diagnosis of Urinary tract infections using urine culture and urine examination.Conclusion: While urine examinations exhibit satisfactory specificity, their sensitivity is insufficient to be utilized as a reliable diagnostic test for detecting urinary tract infections in children. Clinicians are advised to depend on urine culture for accurate diagnosis in such cases.Keywords: Diagnostic accuracy, Pediatrics, Urine Microbiology, Urinalysis, Urinary tract infection.

Should you test for urinary tract infection in children with respiratory symptoms?

An 8-month-old boy presented to our clinic with a 3-day history of fever. He has had a cough and rhinorrhea since the onset of the fever, and his 4-year-old sibling has recently had cough and cold symptoms. I have heard that the presence of respiratory symptoms means that urinary tract infection (UTI) is less likely. In infants with fever and respiratory symptoms, who should have a sample collected for urinalysis for UTI? The approach to diagnosing febrile infants who have respiratory symptoms varies by age. Urinalysis should be done for all febrile infants younger than 2 months of age, regardless of whether they have respiratory symptoms. Clinicians should assess risk factors for UTI in every infant between 2 and 24 months of age and should not exclude the diagnosis of UTI based on respiratory symptoms alone. Use of a predictive tool to estimate the pretest probability of UTI would aid decision making about patients in this population.

A clinical microscopy dataset to develop a deep learning diagnostic test for urinary tract infection

Urinary tract infection (UTI) is a common disorder. Its diagnosis can be made by microscopic examination of voided urine for markers of infection. This manual technique is technically difficult, time-consuming and prone to inter-observer errors. The application of computer vision to this domain has been slow due to the lack of a clinical image dataset from UTI patients. We present an open dataset containing 300 images and 3,562 manually annotated urinary cells labelled into seven classes of clinically significant cell types. It is an enriched dataset acquired from the unstained and untreated urine of patients with symptomatic UTI using a simple imaging system. We demonstrate that this dataset can be used to train a Patch U-Net, a novel deep learning architecture with a random patch generator to recognise urinary cells. Our hope is, with this dataset, UTI diagnosis will be made possible in nearly all clinical settings by using a simple imaging system which leverages advanced machine learning techniques.

Potential System Utilization and Cost Savings of Advanced Microbial Testing for Urinary Tract Infections

Potential System Utilization and Cost Savings of Advanced Microbial Testing for Urinary Tract Infections

Biomarkers for febrile urinary tract infection in children.

The current reference standard for pediatric urinary tract infection (UTI) screening, the leukocyte esterase (LE) dipstick test, has suboptimal accuracy. The objective of this study was to compare the accuracy of novel urinary biomarkers to that of the LE test. We prospectively enrolled febrile children who were evaluated for UTI based on their presenting symptoms. We compared the accuracy of urinary biomarkers to that of the test. We included 374 children (50 with UTI, 324 without UTI, ages 1-35 months) and examined 35 urinary biomarkers. The urinary biomarkers that best discriminated between febrile children with and without UTI were urinary neutrophil gelatinase-associated lipocalin (NGAL), IL-1β, CXCL1, and IL-8. Of all examined urinary biomarkers, the urinary NGAL had the highest accuracy with a sensitivity of 90% (CI: 82-98) and a specificity of 96% (CI: 93-98). Because the sensitivity of the urinary NGAL test is slightly higher than that of the LE test, it can potentially reduce missed UTI cases. Limitations of using urinary NGAL over LE include increased cost and complexity. Further investigation is warranted to determine the cost-effectiveness of urinary NGAL as a screening test for UTI.

Examining antibiotic prescribing and urine culture testing for urinary tract infections (UTIs) in a primary care spinal cord injury (SCI) cohort.

A retrospective cohort study. To describe antibiotic prescribing and urine culture testing patterns for urinary tract infections (UTIs) in a primary care Spinal Cord Injury (SCI) cohort. A primary care electronic medical records (EMR) database in Ontario. Using linked EMR health administrative databases to identify urine culture and antibiotic prescriptions ordered in primary care for 432 individuals with SCI from January 1, 2013 to December 31, 2015. Descriptive statistics were conducted to describe the SCI cohort, and physicians. Regression analyses were conducted to determine patient and physician factors associated with conducting a urine culture and class of antibiotic prescription. The average annual number of antibiotic prescriptions for UTI for the SCI cohort during study period was 1.9. Urine cultures were conducted for 58.1% of antibiotic prescriptions. Fluroquinolones and nitrofurantoin were the most frequently prescribed antibiotics. Male physicians and international medical graduates were more likely to prescribe fluroquinolones than nitrofurantoin for UTIs. Early-career physicians were more likely to order a urine culture when prescribing an antibiotic. No patient characteristics were associated with obtaining a urine culture or antibiotic class prescription. Nearly 60% of antibiotic prescriptions for UTIs in the SCI population were associated with a urine culture. Only physician characteristics, not patient characteristics, were associated with whether or not a urine culture was conducted, and the class of antibiotic prescribed. Future research should aim to further understand physician factors with antibiotic prescribing and urine culture testing for UTIs in the SCI population.

Potential System Utilization and Cost Savings of Advanced Microbial Testing for Urinary Tract Infections

Management of chronic and complex urinary tract infections can be a challenging problem for urologists, emergency department staff, and primary providers. A recent study evaluated the utility of a multiplex polymerase chain reaction–based urinary tract infection analysis, showing noninferiority to classic urine culture testing and possible improvement in identifying polymicrobial infections.1 In addition, this testing benefits from a shorter time to diagnosis with sensitivity testing than traditional culture. Questions remain regarding how this testing might improve patient outcomes and health care utilization. The authors should be commended on their efforts to answer these difficult questions. Ko et al2 found that using polymerase chain reaction technology with pooled antibiotic testing (mPCR/P-AST) in patients with recurrent or complicated urinary tract infections may lead to decreased inpatient utilization and cost savings for the systems compared with standard urine cultures. The average treatment cost for urinary tract infection–related care was decreased by $500 in the mPCR/P-AST group. In addition, 23 percent of patients undergoing the mPCR/P-AST population were able to be treated as an outpatient compared with 53 percent of patients undergoing standard urine cultures. The authors conclude that the mPCR/P-AST approach is associated with reduced resource utilization and costs. Using a matched case-control design, the researchers examined the potential of using mPCR/P-AST in a real-world analysis of a retrospective sample of Medicare beneficiaries with recurrent or complicated urinary tract infections. After an index infection, patients using either the mPCR/P-AST or the standard urine culture exclusively were compared for the following year. The researchers used propensity score matching to mimic randomization by selecting appropriate controls (patients with standard urine culture). They used different statistical models to compare multiple outcomes, including additional urinary tract infections, urinary tract infection–related medical resource utilization, and urinary tract infection–related costs. The ultimate goal of mPCR/P-AST is to improve the care of patients with complex infections by offering faster and possibly improved diagnosis. The primary finding here is an improved rate of outpatient management between testing modalities; however, there is no improvement in rate or number of additional infections. Given the goal of more rapid diagnosis, this shift to outpatient management may hint at earlier microbe-directed treatment of infections compared with a traditional culture, thus preventing hospital admission. However, there is bias introduced by the retrospective design as providers selected their testing modality. A complicated infection may not trigger the need for a PCR test like a chronically catheterized patient with a recurrent infection because of the possibility for improved polymicrobial identification. Thus, selection bias may exist that could lead to inherent management differences between populations. Although the propensity score analysis attempts to address this bias, it can only account for variables measured in the data set and cannot account for unmeasured confounding. Second, the authors found that there was a reduction in costs on a systems level associated with the introduction of polymerase chain reaction testing. They conclude that the use of this method will help to reduce cost secondary to reduction in hospitalization for patients managed with this modality. As this was a study intended to examine resource utilization, the authors elected not to include the cost of the polymerase chain reaction testing in their final costs. Although increased outpatient utilization is a benefit from the patient perspective, the increased cost of testing, upward of $1,000, may be prohibitive to payers. Additional cost-benefit analyses are warranted. This study takes on the admirable challenge of evaluating a real-world population with thoughtful population definitions and analyses. There is undoubtedly a potential benefit to more efficient testing both for patients and the health care system; however, further study is necessary to confirm these findings.

GPs' perspectives on diagnosing childhood urinary tract infections: a qualitative study.

BackgroundDiagnosis and management of childhood urinary tract infection (UTI) is challenging in general practice because of a range of factors.AimTo explore GPs’ perspectives concerning the barriers to and facilitators for diagnosis and management of childhood UTI.Design and settingQualitative study in general practice in Belgium.MethodSemi-structured interviews with 23 GPs from January 2021 to June 2021 were carried out. Interviews were video-recorded and audio-recorded, transcribed verbatim, and analysed using a thematic approach.ResultsThe barriers to early diagnosis of UTI were the assumption of low UTI prevalence and aspecific presentation of UTI in children, difficulties in urine collection, and diagnostic uncertainty. All GPs indicated that they sampled urine in either children with specific UTI features (for example, dysuria, abdominal pain) or unexplained fever. Facilitators for UTI screening were instructional material for parents, skill training for GPs, additional nursing staff, novel non-invasive convenient collection methods, online decision support informing parents when to bring a urine sample to the consultation, and an accurate, easy-to-use point-of-care test for UTI. Empirical antibiotic treatment was initiated based on dipstick test results, clinical features suggestive of UTI, severity of illness, gut feeling, long duration of fever, time of the day, and parents’ ability to judge disease severity.ConclusionThe assumption of a low UTI prevalence, absence of obvious UTI features, and difficult urine sampling might cause childhood UTIs to go undetected in general practice. Diagnostic uncertainty makes appropriate treatment challenging.

Maternal and Perinatal Outcome of Urinary Tract Infection in Pregnancy at Dhulikhel Hospital, Kathmandu University Hospital

Background Urinary tract infection (UTI) is common in pregnancy and poses a great challenge because it has several adverse outcomes in both the mother and her unborn foetus.
 Objective This study aims to determine the incidence of culture positive urinary tract infection, culture and sensitivity of the common causative organisms and find out the maternal and perinatal outcomes in culture positive urinary tract infection.
 Method This prospective study was carried out in the Department of Obstetrics and Gynaecology at Dhulikhel Hospital over a period of one year. Urine routine and microscopy was done as a preliminary screening test for urinary tract infection and those with abnormal results were subjected to urine culture and sensitivity and ultrasonological evaluation.
 Result A total of 162 pregnant women were included in the study. Incidence of culture positive urinary tract infection was 25.9%, highest in age group 15-20 years (47.8%), more in primigravida (30.1%) and common at second trimester (40.4%). Escherichia coli (90.4%) was the commonest organism isolated and ceftriaxone was the most sensitive antibiotic. Patients with culture positive urinary tract infection had higher incidence of anaemia, preterm labour, need of surgical intervention. Such patients also had increased chances of preterm delivery, low birth weight babies and newborn intensive care unit (NICU) admission.
 Conclusion We conclude that urinary tract infection in pregnancy leads to adverse maternal and fetal outcomes. And we recommend urine culture and sensitivity at each trimester so that urinary tract infection can be diagnosed and treated on time.

Diagnostic value of different urine tests for urinary tract infection: a systematic review and meta-analysis.

BackgroundThere are differences in specificity and sensitivity of different routine urine tests for urinary tract infection, so meta-analysis was used to compare the diagnostic value of various urine analysis and detection methods in urinary tract infection, including bacterial culture, urine sediment microscopy, automated urinalysis, and routine urine dry chemical methods.MethodsThe PubMed, Embase, Cochrane Library, SpringerLink, CNKI, and Wanfang databases were searched from inception to December 2021. Two system assessors independently screened the literature according to the inclusion and exclusion criteria. RevMan version 5.3 (the Cochrane Collaboration) and Meta-DiSc were used to calculate the combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic ratio (DOR) of the diagnostic tests and draw summary receiver operating characteristic (SROC) curves.ResultsA total of 14 documents were included according to the inclusion and exclusion criteria. There was a significant statistical difference between the urine sediment microscopy group and the urine normalization group in urine leucocyte detection (OR =2.15, 95% CI: 1.29–3.56, P=0.003, I2=19%, Z=2.95), urine erythrocyte test (OR =1.87, 95% CI: 1.13–3.09, P=0.01, I2=0%, Z=2.45), quantitative determination of urinary protein composition (OR =2.32, 95% CI: 1.27–4.23, P=0.006, I2=30%, Z=2.73), and determination of urinary enzymes (OR =1.67, 95% CI: 1.03–2.72, P=0.04, I2=0%, Z=2.07).DiscussionWhen examining red and white blood cells in urinary tract infection diagnosis, urine dry chemistry is superior to automated urinalysis in terms of area under the curve (AUC), Sen, Spe, etc. When examining urine bacteria, urine dry chemistry can be recommended for urine bacteria screening, with bacterial culture required for confirmation.

Women's information needs around urine testing for urinary tract infections: a qualitative study.

BackgroundUrinary tract infection (UTI) is one of the commonest bacterial infections in general practice, with urine testing a frequent feature of its management. Urinary dipsticks are widely used, with urine culture the reference standard test. To avoid contamination, patients are advised to discard the first part of the urine stream, retaining the midstream part for the sample. This process, however, can be challenging both to explain and to perform. There is a lack of literature investigating women’s perceptions and understanding of urine sampling.AimTo explore women’s understanding of urine collection, sample contamination, and how information from samples informed UTI management.Design and settingQualitative study embedded in a UK randomised controlled trial (RCT) of urinary collection devices (UCDs) among women attending primary care with a suspected UTI.MethodSemi-structured telephone interviews were conducted with 29 women participating in the RCT. Interviews were transcribed and thematically analysed.ResultsParticipants were not always aware about what midstream samples were and why they were preferable. They also lacked understanding about how urine samples may be contaminated, and sources of contamination. Participants experienced variability in the information received following analysis of their sample.ConclusionProvision of clear information could help provide better urine samples, aiding the diagnosis of UTIs, presenting results with greater clarity, and creating less need for repeat samples. Sharing of information derived from uncontaminated samples may also support better UTI management, helping to reduce unnecessary prescribing and antibiotic resistance.

Clinical Study on Routine Urine Test for Urinary Tract Infection

Clinical Study on Routine Urine Test for Urinary Tract Infection

Clinical Usefulness of BACT Count and BACT-Info Flag of UF-5000 for Screening for Urinary Tract Infection and Prediction of Gram-Negative Bacteria.

A rapid and reliable screening test for urinary tract infection (UTI) is needed to reduce the turn-around time and to rule out negative results of urine culture. The aim of this study was to evaluate the performance of BACT count and BACT-Info flag of the UF-5000 for screening for UTI. A total of 1,063 urine specimens from April to September 2019 were included in this study. We evaluated the diagnostic performance of white blood cell (WBC) count, BACT count, BACT-Info flag, and UTI flag in UF-5000 by comparing with the urine culture results. Of the urine specimens, 16.7% were culture-positive (≥ 105 CFU/mL) with 15 being yeast positive. A BACT count of > 685.3/µL showed the best diagnostic performance with 93.8% sensitivity and 90.2% specificity. We confirmed that the combination of BACT count (685.3/µL) and BACT-Info flag would be appropriate to use in a clinical laboratory (sensitivity 91.5%, specificity 90.5%). Based on this combination, the sensitivity and specificity of the Gram-negative flag were 95.5% and 94.8%. We recommend the use of a combination of BACT count (685.3/µL) and BACT-Info for UTI diagnosis. This combination is more appropriate for Gram-negative bacteria, and it would be useful for selecting empirical treatment.

Label-Free, Novel Electrofluidic Capacitor Biosensor for Prostaglandin E2 Detection toward Early and Rapid Urinary Tract Infection Diagnosis.

Urine Prostaglandin E2 (PGE2) has been identified as an attractive diagnostic and prognostic biomarker for urinary tract infection (UTI). This work demonstrates the use of PGE2 as a biomarker for rapid and label-free testing for UTI. In this work, we have developed a novel electrofluidic capacitor-based biosensor that can used for home-based UTI management with high accuracy in less than 5 min for small volume urine samples (<60 μL). The PGE2 biosensor works on the principle of affinity capture using highly specific monoclonal PGE2 antibody and relies on non-faradaic electrical impedance spectroscopy (EIS) and Mott-Schottky (MS) for quantifying subtle variations in PGE2 levels expressed in human urine (pH 5-8). Dynamic light scattering experiments were performed to characterize surface charge properties and the impact of bulk interferents on the interfacial modulation of electrical properties due to binding and urine pH variations. Binding chemistry between the key elements of the immunosensor stack was validated using attenuated total reflectance-Fourier transform infrared spectroscopy and surface plasmon resonance studies. Linear calibration dose responses were obtained for PGE2 for both EIS and MS. The sensor reliably distinguished between UTI negative and UTI positive cases for both artificial (pH 5-8) and pooled human urine samples. The sensor was not found to cross-react with Prostaglandin D2, a structurally similar interferent, and other abundant urine interferents (urea and creatinine). Human subject studies confirmed the validity of the sensor for robust and accurate UTI diagnosis. This work can be extended to achieve easy, reliable, and rapid home-based UTI management, which can consequently help physicians with timely and appropriate administration of therapy to improve patient outcomes and treatment success.

Multi-Health System Comparison of Outpatient Diagnostic Testing for Urinary Tract Infection

Abstract Introduction/Objective Comparisons of diagnostic test utilization for outpatient encounters across multiple health systems are uncommon. Such comparisons are helpful to establish baseline diagnostic testing patterns across health systems. Methods/Case Report Using the Vizient Clinical Database, we compared the number of clinical laboratory tests (CPT codes 80000-89999) and imaging studies (CPT codes 70000-79999) per outpatient encounter for patients with urinary tract infection (UTI, N=97,714) or dysuria (N=125,388). We employed primary ICD-10 codes for UTI (N39.0) and dysuria (R30.0, R30.9, R35.0, R39.15) to define each patient group. We measured the aggregate Clinical Resource Intensity Weight (RIW) per outpatient visit to quantify diagnostic resource consumption for each encounter. The RIW is based on the US Centers for Medicare and Medicaid Services (CMS) Ambulatory Payment Classification (APC) weights. CMS assigns an APC weight to each diagnostic test based on the geometric mean cost of each particular test. We compared diagnostic testing at 20 academically affiliated health systems across the United States (2017- 2019) with &amp;gt;500 annual outpatient visits for UTI and dysuria. We also examined two relevant tests: urinalysis (CPT codes 8100, 81001, 81002, 81003, 81005, 81007, and 81015) and basic urine culture (CPT code 87086) testing patterns. Results (if a Case Study enter NA) The mean number of laboratory tests was 4.30 tests (range 3.04-5.89) and 3.01 (range 2.41-3.86) for UTI and dysuria patients, respectively. Average laboratory RIW and quantity were moderately correlated with a mean RIW of 0.50 and 0.38 for UTI and dysuria patients, respectively. The mean number of imaging studies for each group was 0.26 (range 0.08-0.46) and 0.05 (range 0.01-0.14), respectively. Average imaging RIW and quantity were more highly correlated with a mean RIW of 0.52 and 0.11 for UTI and dysuria patients, respectively. UTI encounters averaged 0.78 (range 0.38-1.28) urinalysis tests and 0.65 (range 0.39-0.86) urine cultures. Dysuria patient visits averaged 0.77 (range 0.45-1.17) urinalysis tests and 0.58 (range 0.13-0.76) urine cultures. Conclusion There are significant differences in diagnostic tests and resource utilization between large health systems for patients with UTI and dysuria. These differences persist with specific test comparisons for urinalysis and urine culture.

Neutrophil gelatinase-associated lipocalin for urinary tract infection and pyelonephritis: a systematic review.

The sensitivity and specificity of the leukocyte esterase test are relatively low for a screening test for urinary tract infection (UTI). More accurate tests could reduce both overtreatment and missed cases. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) can replace leukocyte esterase in the diagnosis of UTI and/or whether NGAL accurately identifies children with acute pyelonephritis. Data sources-MEDLINE and EMBASE. We only considered published studies that evaluated the results of an index test (NGAL) against the results of urine culture (for UTI) or against the results of dimercaptosuccinic acid (for acute pyelonephritis) in children aged 0 to 18years. Two authors independently applied the selection criteria to all citations and independently extracted the data. A total of 12 studies met our inclusion criteria. Four studies (920 children) included data on NGAL for UTI; eight studies (580 children) included data on NGAL for pyelonephritis. We did not pool accuracy values because the included studies used different cutoff values. For the diagnosis of UTI, urinary NGAL appeared to have better accuracy than the leukocyte esterase test in all included studies. For the diagnosis of pyelonephritis, neither plasma NGAL nor urinary NGAL had high sensitivity and/or specificity. The number of studies was the main limitation of this systematic review. Urinary NGAL appears promising for the diagnosis of UTI; however, larger studies are needed to validate this marker as a replacement for leukocyte esterase. The use of NGAL for diagnosing acute pyelonephritis requires further study.

Reevaluating the true diagnostic accuracy of dipstick tests to diagnose urinary tract infection using Bayesian latent class analysis.

Previous studies on diagnostic accuracy of dipstick testing for leukocyte esterase (LE) and nitrite to diagnose urinary tract infection (UTI) had used urine culture, which is an imperfect gold standard. Estimates of diagnostic accuracy obtained using the classical gold standard framework might not reflect the true diagnostic accuracy of dipstick tests. We used the dataset from a prospective, observational study conducted in the emergency department of a teaching hospital in southern India. Patients with a clinical suspicion of UTI underwent dipstick testing for LE and nitrite, urine microscopy, and urine culture. Based on the results of urine microscopy and culture, UTI was classified into definite, probable, and possible. Patients with microscopic pyuria and a positive urine culture were adjudicated as definite UTI. Unequivocal imaging evidence of emphysematous pyelonephritis or perinephric collections was also considered definite UTI. We estimated the diagnostic accuracy of LE and nitrite tests using the classical analysis (assuming definite UTI as gold standard) and two different Bayesian latent class models (LCMs; 3-tests in 1-population and 2-tests in 2-populations models). We studied 149 patients. Overall, 64 (43%) patients had definite, 76 (51%) had probable, and 2 (1.3%) had possible UTI; 7 (4.6%) had alternate diagnoses. In classical analysis, LE was more sensitive than nitrite (87.5% versus 70.5%), while nitrite was more specific (24% versus 58%). The 3-tests in 1-population Bayesian LCM indicated a substantially better sensitivity and specificity for LE (98.1% and 47.6%) and nitrite (88.2% and 97.7%). True sensitivity and specificity of urine culture as estimated by the model was 48.7% and 73.0%. Estimates of the 2-tests in 2-populations model were in agreement with the 3-tests in 1-population model. Bayesian LCMs indicate a clinically important improvement in the true diagnostic accuracy of urine dipstick testing for LE and nitrite. Given this, a negative dipstick LE would rule-out UTI, while a positive dipstick nitrite would rule-in UTI in our study setting. True diagnostic accuracy of urine dipstick testing for UTI in various practice settings needs reevaluation using Bayesian LCMs.

A novel screening method for pediatric urinary tract infection using ordinary diapers

Urinary tract infection (UTI) is one of the most common bacterial infections in children. The symptoms of UTI in young children are nonspecific, therefore urine should be examined whenever UTI cannot be ruled out. In clinical settings, however, collecting urine from children who are not toilet trained is sometimes difficult, presenting a challenge in UTI management. Here, we developed a “diaper UTI test”, which enables the quick detection of pyuria in ordinary diapers, and investigated its sensitivity and specificity in a clinical study. The diaper UTI test is based on a leukocyte esterase reaction. Reagent was prepared in liquid form so that it can be absorbed by disposable diapers, where it will produce a violet color in the presence of pyuria. For the clinical study, we enrolled children younger than 3 years with potential UTI who underwent bladder catheterization for urine culture and urinalysis. Of the 65 children included, 21 were diagnosed with UTI. The sensitivity and specificity of the diaper UTI test were 90.5% (95% CI 69.6–98.8) and 93.2% (95% CI 81.3–98.6), respectively. Because of its convenience and good sensitivity, the diaper UTI test may be useful in the screening of pediatric UTI.

Beta-lactam antibiotics induced bacteriolysis on LSPR sensors for assessment of antimicrobial resistance and quantification of antibiotics

Antimicrobial resistance affecting humans is fueled by empirical infection diagnostics and continuous unintended antibiotics exposure. A localized surface plasmon resonance (LSPR) based optical fiber biosensor for capture of bacteria followed by antibiotic mediated lysis has been demonstrated for quick drug susceptibility testing. The concept has been proven with P. aeruginosa and E. coli suspended in simulated human urine for potential drug susceptibility testing for urinary tract infections. P. aeruginosa RS1 was found to be selectively sensitive to commonly used third generation cephalosporins ceftazidime, ceftriaxone and cefotaxime. Hence, in an alternate scheme, bacteriolysis signatures of P. aeruginosa immobilized on gold nanoparticles modified optical fibers was used for quantification of third generation cephalosporins over a linear range of 0.01 to 1 μg/ml, R2 = 0.985, in water. Further, this principle was established for therapeutic drug monitoring (TDM) of the said antibiotics in real human serum in the therapeutic relevant range of 0.5 to 10 μg /mL (R2 = 0.987). This sensor provides a quick alternative to cumbersome Kirby-Bauer disk diffusion tests, practiced in most community health settings and tertiary care hospitals for drug susceptibility testing. The sensor also provides an alternative to chromatography coupled mass spectroscopic techniques for quicker, affordable and possibly point of care antibiotic quantification with applications in environmental and therapeutic monitoring.

592 Prevention of CAUTIs in a Burn ICU

Abstract Introduction Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-associated infection (HAI). Urinary catheter use is associated with urinary tract infections (UTIs) that can lead to complications such as cystitis, pyelonephritis, bacteremia, septic shock, and death. CAUTIs are associated with an excess length of stay of 2–4 days, increase costs of $0.4–0.5 billion per year nationally, and lead to unnecessary antimicrobial use. Through numerous implementations, a Burn ICU was able to drastically decrease their incidence of CAUTIs. Methods A Burn ICU implemented several interventions to reduce CAUTI rates. These interventions included: Results When this project was initiated in September of 2017, there were 9 CAUTIs identified in a Burn ICU, per the hospital’s Infection Prevention Department. By the end of 2017, there were 11, which equated to a rate of 14.67 per 1000 urinary catheter days. In 2018, the Burn ICU had 1 CAUTI, with a rate of 1.92 per 1000 urinary catheter days. In 2019 (through quarter 2), the Burn ICU has not had a CAUTI per the Infection Prevention Department. We believe the interventions made have drastically decreased the incidence of CAUTIs. Conclusions A Burn ICU implemented many new practices in 2017 when the CAUTI rate and SIR were above the hospital’s overall SIR. The Burn ICU staff now practice proper care and maintenance of urinary catheters and continue to provide excellent care. Although we have decreased our incidence of CAUTIs for 2018 and 2019, it is equally important we sustain this improvement. Therefore, we will continue to provide an open forum for discussion with staff so we can all do our part in keeping patients safe. Applicability of Research to Practice A Burn ICU decreased the incidence of CAUTIs by educating staff on proper care and maintenance of urinary catheters, removing catheters as soon as possible, and testing for UTIs upon admission to determine the patient’s baseline. By doing so, CAUTI rates went from 14.67 to 0 per 1000 urinary catheter days.