Author/Authors :
J. Frederick، نويسنده , , Stephen C. Woods، نويسنده ,
Abstract :
BACKGROUND/OBJECTIVES: Consensus definitions for infection control surveillance in long-term care were published in 1991 (McGeer). These definitions rely on clinical symptoms and minimal laboratory criteria. However, with increasing antibiotic resistance in LTCF, there has been increased emphasis on culturing patients. The Centers for Disease Control and Prevention (CDC) surveillance definitions are laboratory and symptom based and used primarily in acute care facilities. In facilities with both acute care and long-term care components, it is unclear which definitions are most appropriate. This study sought to compare the two sets of definitions for UTIs in a long-term care facility with access to both laboratory and radiology support.
METHODS: The study was conducted in a 120-bed Veterans Affairs extended-care facility physically attached to an acute care hospital. Laboratory services were shared with the acute care hospital. A standardized chart review was conducted on all long-term patients with a urine culture sent to microbiology. Each episode was evaluated by both the McGeer and CDC criteria. Geriatric nurse practitioners and rotating medical interns and residents under supervision of a geriatric fellow and attending provided clinical care.
RESULTS: Over a 14-month period, 312 non-sterile urine cultures from 146 patients were reviewed. Clinicians treated 116 for UTI, of these 57 (49%) did not meet either criteria, of the remaining 59, 32 met both sets of criteria, 21 met McGeer only, and 4 met CDC only. In 15 patients, a clinical indicator not included in either definition was elevated glucose or increased difficulty maintaining control of blood glucose level.
CONCLUSION: Almost half (49%) of the treated UTI met did not meet either surveillance definition. In this population, even with the ready availability of laboratory support, the McGeer definition identified more of the UTIs than did the CDC surveillance definitions.
