Factors Associated with Mortality in Critically Injured Trauma Patients Who Require Simultaneous Cultures

Montalvo, J; Acosta, José A.; Rodríguez, Pablo; Hatzigeorgiou, Christos; Gonzalez, B.; Calderín, Alma R.

doi:10.1089/sur.2006.7.137

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Although suprapubic tenderness, flank tenderness, and delirium have been proposed as clinical signs and symptoms of CAUTI, their reliability and validity have not been evaluated in the hospital setting. Furthermore, while fever is an important clinical sign that often triggers clinicians to examine a patient for sources of infection and inflammation (Juthani-Mehta et al, 2005;Levy et al, 2006;Montalvo et al, 2006), it has been shown to have poor specificity for CAUTI (Golob et al, 2008;Orr et al, 1996;Tambyah & Maki, 2000a). However, two studies that examined fever as an indicator of CAUTI relied upon retrospective temperature data found in the medical record (Golob et al, 2008;Tambyah & Maki, 2000a), and the third study occurred in a long-term care facility (Orr et al, 1996).…”

Section: Clinical Manifestations Of Cautimentioning

confidence: 99%

The reliability and diagnostic validity of clinical manifestations of catheter-associated urinary tract infection in hospitalized adults

Blodgett¹

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Catheter-associated urinary tract infection is a common clinical condition among hospitalized patients with numerous health and economic implications. With judicious use of indwelling urinary catheters, along with strict adherence to basic infection prevention measures, such as hand hygiene and aseptic technique during catheter insertion, these infections are most often preventable. However, these devices continue to be used inappropriately or unnecessarily, which has led the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and numerous infectious disease professional societies to focus attention on how these infections can be diagnosed, prevented, and managed. Despite these efforts, consensus on how best to identify cases of CAUTI has been elusive.Perhaps the most widely used guidelines for the diagnosis, prevention, and treatment of CAUTI are those published in 2010 in the American Journal of Infection Control by Hooton and colleagues. These authors are very clear that CAUTI is a problem if, and only if, it is associated with clinical manifestations; the presence of urinary microorganisms alone is not a clear indication for antimicrobial therapy. Moreover, these authors provide a list of accepted clinical manifestations of CAUTI, which are substantially different from those in previous guidelines. Among others, the manifestations listed include: fever, suprapubic tenderness, flank tenderness, and delirium. However, these are supported by expert opinion only, and neither their diagnostic validity nor their inter-rater reliability have been reported in the literature.The purpose of this study was to test the feasibility of methods to examine the diagnostic validity and inter-rater reliability of fever, suprapubic tenderness, flank 2 tenderness, and delirium in hospitalized adult with an indwelling urinary catheter.Briefly, these clinical manifestations were compared against three diagnostic criteria for CAUTI based on microbiologic and molecular methods, and their inter-rater reliability was examined using assessments conducted by three advanced practice nurses.Because significant microbial growth was only present in two urine samples, the diagnostic validity of these manifestations could not be established. However, it was possible to examine the inter-rater reliability of these manifestations. To summarize these findings, the nurse raters were in perfect agreement with the identification of fever, moderate agreement with the identification of delirium, and fair agreement with the identification of suprapubic tenderness and flank tenderness. With the exception of flank tenderness, these findings are statistically significant, and they provide evidence that nurses can consistently identify the presence and absence of fever, suprapubic tenderness, and delirium in hospitalized patients with indwelling urinary catheters. This study provided preliminary findings that support the need for further investigation of the diagnostic validity of clinical manifestations o...

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Section: Clinical Manifestations Of Cautimentioning

confidence: 99%

The reliability and diagnostic validity of clinical manifestations of catheter-associated urinary tract infection in hospitalized adults

Blodgett¹

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Fever and Leukocytosis in Critically Ill Trauma Patients: It's Not the Urine*

Golob

Claridge

Sando

et al. 2008

Surgical Infections

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The practice of obtaining a UCx from the STICU trauma patient was related to fever and fever with leukocytosis. However, neither fever nor leukocytosis nor both were associated with UTIs. These data suggest that there is an unnecessary emphasis on UTI as a source of fever and leukocytosis in injured patients during their first 14 STICU days. Our results suggest that the paradigm for evaluating UTI as a cause of fever needs to be reevaluated in critically ill trauma patients.

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Improved Survival of Critically Ill Trauma Patients Treated With Recombinant Human Erythropoietin

Napolitano

Fabian

Kelly

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Factors Associated with Mortality in Critically Injured Trauma Patients Who Require Simultaneous Cultures

Abstract: In this group of patients, growth of bacteria in simultaneous cultures was associated with higher mortality-a factor that may be considered a poor prognostic indicator. This factor requires further studies to explore the relation with survival in critically injured patients.

Cited by 3 publications

References 26 publications

The reliability and diagnostic validity of clinical manifestations of catheter-associated urinary tract infection in hospitalized adults

The reliability and diagnostic validity of clinical manifestations of catheter-associated urinary tract infection in hospitalized adults

Fever and Leukocytosis in Critically Ill Trauma Patients: It's Not the Urine*

Improved Survival of Critically Ill Trauma Patients Treated With Recombinant Human Erythropoietin

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