Einzeltreffer — DigiBib

For acute medicine physicians, distinguishing between asymptomatic bacteriuria (ABU) and clinically relevant urinary tract infections (UTI) is challenging, resulting in overtreatment of ABU and under-recognition of urinary-source bacteraemia without genitourinary symptoms (USB). We conducted a retrospective analysis of ED encounters in a university hospital between October 2013 and September 2018 who met the following inclusion criteria: Suspected UTI with simultaneous collection of paired urinary cultures and blood cultures (PUB) and determination of Procalcitonin (PCT). We sought to develop a simple algorithm based on clinical signs and PCT for the management of suspected UTI. Individual patient presentations were retrospectively evaluated by a clinical "triple F" algorithm (F1 ="fever", F2 ="failure", F3 ="focus") supported by PCT and PUB. We identified 183 ED patients meeting the inclusion criteria. We introduced the term UTI with systemic involvement (SUTI) with three degrees of diagnostic certainty: bacteremic UTI (24.0%; 44/183), probable SUTI (14.2%; 26/183) and possible SUTI (27.9%; 51/183). In bacteremic UTI, half of patients (54.5%; 24/44) presented without genitourinary symptoms. Discordant bacteraemia was diagnosed in 16 patients (24.6% of all bacteremic patients). An alternative focus was identified in 67 patients, five patients presented with S. aureus bacteremia. 62 patients were diagnosed with possible UTI (n = 20) or ABU (n = 42). Using the proposed "triple F" algorithm, dichotomised PCT of < 0.25 pg/ml had a negative predictive value of 88.7% and 96.2% for bacteraemia und accordant bacteraemia respectively. The application of the algorithm to our cohort could have resulted in 33.3% reduction of BCs. Using the diagnostic categories "possible" or "probable" SUTI as a trigger for initiation of antimicrobial treatment would have reduced or streamlined antimicrobial use in 30.6% and 58.5% of cases, respectively. In conclusion, the "3F" algorithm supported by PCT and PUB is a promising diagnostic and antimicrobial stewardship tool.

Competing Interests: The authors have declared that no competing interests exist.

Titel:	A diagnostic algorithm for detection of urinary tract infections in hospitalized patients with bacteriuria: The "Triple F" approach supported by Procalcitonin and paired blood and urine cultures.
Autor/in / Beteiligte Person:	Rothe, K ; Spinner, CD ; Waschulzik, B ; Janke, C ; Schneider, J ; Schneider, H ; Braitsch, K ; Smith, C ; Schmid, RM ; Busch, DH ; Katchanov, J
Link:	Zum Volltext
Zeitschrift:	PloS one, Jg. 15 (2020-10-22), Heft 10, S. e0240981
Veröffentlichung:	San Francisco, CA : Public Library of Science, 2020
Medientyp:	academicJournal
ISSN:	1932-6203 (electronic)
DOI:	10.1371/journal.pone.0240981
Schlagwort:	Aged Aged, 80 and over Algorithms Bacteremia microbiology Bacteriuria diagnosis Blood Culture methods Cohort Studies Female Humans Male Middle Aged Staphylococcus aureus isolation & purification Urinary Tract Infections metabolism Blood microbiology Procalcitonin metabolism Urinary Tract Infections diagnosis Urine microbiology
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [PLoS One] 2020 Oct 22; Vol. 15 (10), pp. e0240981. <i>Date of Electronic Publication: </i>2020 Oct 22 (<i>Print Publication: </i>2020). MeSH Terms: Blood / microbiology ; Procalcitonin / metabolism ; Urinary Tract Infections / diagnosis ; Urine / microbiology ; Aged ; Aged, 80 and over ; Algorithms ; Bacteremia / microbiology ; Bacteriuria / diagnosis ; Blood Culture / methods ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Staphylococcus aureus / isolation & purification ; Urinary Tract Infections / metabolism References: BMJ Open. 2019 Aug 10;9(8):e031269. (PMID: 31401614) ; Microbiol Spectr. 2015 Oct;3(5):. (PMID: 26542046) ; Crit Care. 2010;14(6):R206. (PMID: 21083886) ; BMC Med. 2017 Jan 24;15(1):15. (PMID: 28114931) ; Infect Dis Clin North Am. 2014 Mar;28(1):75-89. (PMID: 24484576) ; Clin Infect Dis. 2010 Jun 1;50(11):e69-72. (PMID: 20420504) ; Acad Emerg Med. 1997 Aug;4(8):797-800. (PMID: 9262699) ; J Emerg Med. 2008 Oct;35(3):255-64. (PMID: 18486413) ; Microbiol Spectr. 2016 Oct;4(5):. (PMID: 27780014) ; Infect Chemother. 2017 Mar;49(1):22-30. (PMID: 28271650) ; Curr Opin Infect Dis. 2016 Feb;29(1):73-9. (PMID: 26694621) ; Eur Urol. 2007 May;51(5):1394-401. (PMID: 17207908) ; Int Braz J Urol. 2016 Mar-Apr;42(2):270-6. (PMID: 27256181) ; Clin Infect Dis. 2002 Jun 1;34(11):1524-9. (PMID: 12015700) ; Cochrane Database Syst Rev. 2015 Jan 20;1:CD009185. (PMID: 25603480) ; Am J Emerg Med. 2018 Nov;36(11):1993-1997. (PMID: 29530360) ; Curr Opin Infect Dis. 2015 Feb;28(1):106-11. (PMID: 25402776) ; J Am Geriatr Soc. 2017 Aug;65(8):1650-1655. (PMID: 28542707) ; Clin Infect Dis. 2019 Aug 30;69(6):963-969. (PMID: 30476003) ; JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338) ; Clin Microbiol Infect. 2001 Apr;7(4):173-8. (PMID: 11422238) ; J Emerg Med. 2016 Jul;51(1):25-30. (PMID: 27066953) ; Eur J Emerg Med. 2006 Apr;13(2):76-9. (PMID: 16525233) ; BMC Infect Dis. 2019 Feb 14;19(1):161. (PMID: 30764769) ; Curr Infect Dis Rep. 2010 Nov;12(6):455-64. (PMID: 21308555) ; Braz J Infect Dis. 2009 Aug;13(4):294-6. (PMID: 20231994) ; Eur Radiol. 2006 Feb;16(2):256-68. (PMID: 16341833) ; Clin Infect Dis. 2012 Jun;54(12):1692-8. (PMID: 22431806) ; Emerg Med Clin North Am. 2018 Nov;36(4):685-710. (PMID: 30296999) ; Emerg Med Clin North Am. 2019 Nov;37(4):707-723. (PMID: 31563203) ; Intern Emerg Med. 2020 Jan;15(1):119-125. (PMID: 31650435) ; Dtsch Arztebl Int. 2011 Jul;108(30):515-21. (PMID: 21904584) ; Int J Antimicrob Agents. 2000 Mar;14(2):129-35. (PMID: 10720803) ; Pharmacoeconomics. 2005;23(11):1123-42. (PMID: 16277548) ; J Emerg Med. 2007 Jul;33(1):1-8. (PMID: 17630066) ; Arch Intern Med. 2012 Jan 9;172(1):33-8. (PMID: 22232145) ; N Engl J Med. 2018 Jan 4;378(1):48-59. (PMID: 29298155) ; Curr Opin Urol. 2017 Mar;27(2):133-137. (PMID: 27846034) ; Clin Infect Dis. 2015 Dec 1;61(11):1655-61. (PMID: 26270684) ; QJM. 1996 Jul;89(7):515-22. (PMID: 8759492) ; Epidemiol Infect. 2017 Oct;145(14):3065-3069. (PMID: 28803566) ; West J Emerg Med. 2019 Jul;20(4):573-577. (PMID: 31316695) ; Clin Nephrol. 1997 Jan;47(1):50-1. (PMID: 9021242) ; Infect Control Hosp Epidemiol. 2016 Jun;37(6):749-51. (PMID: 26984672) ; Ann Emerg Med. 2015 Sep;66(3):318-9. (PMID: 26304251) ; BMC Infect Dis. 2019 Jun 7;19(1):504. (PMID: 31174479) ; J Accid Emerg Med. 1998 Jul;15(4):254-6. (PMID: 9681310) ; Clin Infect Dis. 1997 Apr;24(4):584-602. (PMID: 9145732) ; Cochrane Database Syst Rev. 2017 Oct 12;10:CD007498. (PMID: 29025194) ; J Infect. 2010 Dec;61(6):492-8. (PMID: 20833201) Substance Nomenclature: 0 (Procalcitonin) Entry Date(s): Date Created: 20201022 Date Completed: 20201214 Latest Revision: 20201214 Update Code: 20240513 PubMed Central ID: PMC7580978

Klicken Sie ein Format an und speichern Sie dann die Daten oder geben Sie eine Empfänger-Adresse ein und lassen Sie sich per Email zusenden.

BibTeX Citavi, JabRef, u.a.
(Literaturverwaltung)

PDF kein Volltext!
(Merkzettel, Notizen)

RIS Endnote, Citavi u.a.
(Literaturverwaltung)

MODS
(XML zur Weiterverarbeitung)

oder

Wählen Sie das für Sie passende Zitationsformat und kopieren Sie es dann in die Zwischenablage, lassen es sich per Mail zusenden oder speichern es als PDF-Datei.

Gewünschter Zitations-Stil:

oder

Bitte prüfen Sie, ob die Zitation formal korrekt ist, bevor Sie sie in einer Arbeit verwenden. Benutzen Sie gegebenenfalls den "Exportieren"-Dialog, wenn Sie ein Literaturverwaltungsprogramm verwenden und die Zitat-Angaben selbst formatieren wollen.

A diagnostic algorithm for detection of urinary tract infections in hospitalized patients with bacteriuria: The "Triple F" approach supported by Procalcitonin and paired blood and urine cultures.