title: How Often Do Clinically Diagnosed Catheter-Associated Urinary Tract Infections in Nursing Homes Meet Standardized Criteria?
abstract: OBJECTIVE
  To determine the relationship between clinically diagnosed catheter-associated urinary tract infection (CAUTI) and standardized criteria and to assess microorganism-level differences in symptom burden in a cohort of catheterized nursing home (NH) residents.
  
  
  METHODS
  Post hoc analysis of a prospective longitudinal study.
  
  
  METHODS
  Twelve NHs in southeast Michigan.
  
  
  METHODS
  NH residents with indwelling urinary catheters (n = 233; 90% white, 52% male, mean age 73.7).
  
  
  METHODS
  Clinical and demographic data, including CAUTI epidemiology and symptoms, were obtained at study enrollment, 14 days, and monthly thereafter for up to 1 year.
  
  
  RESULTS
  One hundred twenty participants with an indwelling catheter (51%) were prescribed systemic antibiotics for 182 clinically diagnosed CAUTIs. Common signs and symptoms were acute change in mental status (28%), fever (21%), and leukocytosis (13%). Forty percent of clinically diagnosed CAUTIs met Loeb's minimum criteria, 32% met National Health Safety Network (NHSN) criteria, and 50% met Loeb's minimum or NHSN criteria. CAUTIs involving Staphylococcus aureus and Enterococcus spp. were least likely to meet criteria. CAUTIs involving Klebsiella pneumoniae were most likely to meet Loeb's minimum criteria (odds ratio (OR) = 9.7, 95% confidence interval (CI) = 2.3-40.3), possibly because of an association with acute change in mental status (OR = 5.9, 95% CI = 1.8-19.4).
  
  
  CONCLUSIONS
  Fifty percent of clinically diagnosed CAUTIs met standardized criteria, which represents an improvement in antibiotic prescribing practices. At the microorganism level, exploratory data indicate that symptom burden may differ between microorganisms. Exploration of CAUTI signs and symptoms associated with specific microorganisms may yield beneficial information to refine existing tools to guide appropriate antibiotic treatment.
authors.affiliation: Department of Microbiology and Immunology, School of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Chelsie E
authors.initials: CE
authors.lastname: Armbruster
authors.affiliation: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Katherine
authors.initials: K
authors.lastname: Prenovost
authors.affiliation: Department of Microbiology and Immunology, School of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Harry L T
authors.initials: HL
authors.lastname: Mobley
authors.affiliation: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.|Division of Geriatric and Palliative Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Lona
authors.initials: L
authors.lastname: Mody
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D060825:Cognitive Dysfunction / Q000382:microbiology; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D007964:Leukocytosis / Q000382:microbiology; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009735:Nursing Homes; D011446:Prospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: 
  CAUTI
  ; 
  Klebsiella pneumoniae
  ; delirium; infection criteria; nursing homes