title: A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit.
abstract: BACKGROUND
  Urinary tract infection (UTI) in trauma patients is associated with increased mortality. Whether the urinalysis (UA) is an adequate test for a urinary source of fever in the ICU trauma patient has not been demonstrated. We hypothesized that the UA is a valuable screen for UTI in the febrile, critically ill trauma patient.
  
  
  METHODS
  All trauma ICU patients in our surgical ICU who had a fever (temperature >38.0°C), urinary catheter, UA, and a urine culture between January 1, 2011 and December 13, 2011 were reviewed. A positive UA was defined as positive leukocyte esterase, positive nitrite, WBC > 10/high power field, or presence of bacteria. A positive urine culture was defined as growth of ≥10(5) colony forming units (cfu) of an organism irrespective of the UA result or ≥10(3) cfu in the setting of a positive UA. A UTI was defined as positive urine culture without an alternative cause of the fever.
  
  
  RESULTS
  There were 232 UAs from 112 patients that met criteria. The majority (75%) of patients were men; the mean age was 40 (±16) years. Of the 232 UAs, 90 (38.7%) were positive. There were 14 UTIs. The sensitivity, specificity, positive predictive value, and negative predictive value of the UA for UTI were 100%, 65.1%, 15.5%, and 100%, respectively.
  
  
  CONCLUSIONS
  A negative UA reliably excludes a catheter-associated UTI in the febrile, trauma ICU patient with a 100% negative predictive value, and it can rapidly direct the clinician toward more likely sources of fever and reduce unnecessary urine cultures.
authors: Department of Surgery, Denver Health Medical Center and the University of Colorado School of Medicine, Denver, CO 80206, USA. robert.stovall@dhha.org
authors: Robert T
authors: RT
authors: Stovall
authors: James B
authors: JB
authors: Haenal
authors: Timothy C
authors: TC
authors: Jenkins
authors: Gregory J
authors: GJ
authors: Jurkovich
authors: Fredric M
authors: FM
authors: Pieracci
authors: Walter L
authors: WL
authors: Biffl
authors: Carlton C
authors: CC
authors: Barnett
authors: Jeffrey L
authors: JL
authors: Johnson
authors: Denis D
authors: DD
authors: Bensard
authors: Ernest E
authors: EE
authors: Moore
authors: Clay
authors: C
authors: Cothren Burlew
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D003422:Critical Care; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D014947:Wounds and Injuries / Q000150:complications*