Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home residents.
OBJECTIVE
To prospectively evaluate nursing home residents with suspected urinary tract infection (UTI) to determine whether they met the McGeer, Loeb, or revised Loeb consensus-based criteria and whether any set of criteria was associated with laboratory evidence of UTI, namely bacteriuria (>100,000 colony forming units) plus pyuria (>10 white blood cells).


METHODS
Prospective cohort study.


METHODS
Three New Haven-area nursing homes.


METHODS
Of 611 residents screened, 457 were eligible, 362 consented, and 340 enrolled.


METHODS
Participants underwent prospective surveillance from May 2005 to April 2006 for the development of suspected UTI (defined as a participant's physician or nurse clinically suspecting UTI). One hundred participants with suspected UTI and a urinalysis and urine culture performed were included in the analyses.


RESULTS
Participants were identified who met the criteria of McGeer, Loeb, revised Loeb, and laboratory evidence of UTI. Using laboratory evidence of UTI as the outcome, the McGeer criteria demonstrated 30% sensitivity, 82% specificity, 57% positive predictive value (PPV), and 61% negative predictive value (NPV); the Loeb criteria showed 19% sensitivity, 89% specificity, 57% PPV, and 59% NPV; and the revised Loeb criteria demonstrated 30% sensitivity, 79% specificity, 52% PPV, and 60% NPV.


CONCLUSIONS
All of the consensus-based criteria have similar test characteristics. The diagnostic accuracy of UTI criteria in nursing home residents could be improved, and the data suggest that evidence-based clinical criteria associated with laboratory evidence of UTI need to be identified and validated.
Juthani-Mehta
Manisha
M
Department of Internal Medicine, Section of Infectious Disease, Yale University School of Medicine, New Haven, Connecticut 06520, USA. manisha.juthanimehta@yale.edu
Tinetti
Mary
M
Perrelli
Eleanor
E
Towle
Virginia
V
Van Ness
Peter H
PH
Quagliarello
Vincent
V
D000368:Aged; D000369:Aged, 80 and over; D003950:Diagnostic Techniques, Urological / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D007297:Inpatients; D008297:Male; D009735:Nursing Homes; D011159:Population Surveillance; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology