Urinary tract infection Surveillance

 

UTI is considered the most common Health care associated infections almost 33% of all HAI infections that increased by indwelling a urinary catheters and infection can caused by either endogenous or exogenous pathogens with the most common are : E.coli,Klebsiella spp., and P. aeruginosa. , enterococci and Enterobacter spp and Candida in ICU while abusing the Antibiotics is more common so we have to do a proper Urinary tract infection Surveillance 

Urinary tract infection Surveillance

Urinary tract infection Surveillance

 

CDC established a criteria for surveillance of UTI and the UTI as a major type of Infection was classified into three specific types of infections

  1. Symptomatic UTI
  2. Asymptomatic Urinary Tract Infection
  3. Other Urinary Tract Infection (kidney, ureter, bladder, urethra, or tissue surrounding the retroperineal or perinephric space)

 

1-      Symptomatic UTI

 

1.1 Patient with indwelling urinary Catheter

 

  • For this specific type Patient has to have an indwelling urinary catheter in place for >2 calendar days, , and catheter was in place time when all elements of this criterion were first present together and at least 1 of the following signs or symptoms: fever (>38°C); suprapubic tenderness; costovertebral angle pain or tenderness and a positive urine culture of ≥105 (CFU)/ml with no more than 2 species of microorganisms.

 

  • Patient with  indwelling catheter in place for >2 calendar days and had it removed the day of or the day before all elements of this criterion were first present together and at least 1 of the following signs or symptoms: fever (>38°C); urgency; frequency; dysuria; suprapubic tenderness; costovertebral angle pain or tenderness and a positive urine culture of ≥105 (CFU)/ml with no more than 2 species of microorganisms.

 

  • Patient with  indwelling catheter in place for >2 calendar days, and catheter was in place when all elements of this criterion were first present together and at least 1 of the following signs or symptoms: fever (>38°C); suprapubic tenderness*; costovertebral angle pain or tenderness and at least 1 of the following findings:

 

a. positive dipstick for leukocyte esterase and/or nitrite

b. pyuria (urine specimen with ≥10 white blood cells [WBC]/mm3 of unspun urine or >5 WBC/high power field of spun urine)

c. microorganisms seen on Gram’s stain of unspun urine

 

And a positive urine culture of ≥103 and <105 CFU/ml with no more than 2 species of microorganisms.

 

  • Patient with indwelling catheter in place for >2 calendar days and had it removed the day of or the day before all elements of this criterion were first present together and at least 1 of the following signs or symptoms: fever (>38°C); urgency; frequency; dysuria; suprapubic tenderness; costovertebral angle pain or tenderness and at least 1 of the following findings:

a. positive dipstick for leukocyte esterase and/or nitrite

b. pyuria (urine specimen with ≥10 WBC/mm3 of unspun urine or >5 WBC/high power field of spun urine

c. microorganisms seen on Gram’s stain of unspun urine

And a positive urine culture of ≥103 and <105 CFU/ml with no more than 2 species of microorganisms.

 

1.2  Patient without indwelling urinary Catheter

 

  • Patient without indwelling catheter in place at the time of or the day before all elements of this criterion were first present together and has at least 1 of the following signs or symptoms: fever (>38°C) in a patient that is ≤65 years of age; urgency; frequency; dysuria; suprapubic tenderness; costovertebral angle pain or tenderness and a positive urine culture of ≥105 CFU/ml with no more than 2 species of microorganisms.

 

  • Patient without  indwelling catheter in place at the day before all elements of this criterion were first present together and has at least 1 of the following signs or symptoms: fever (>38°C) in a patient that is ≤65 years of age; urgency; frequency; dysuria; suprapubic tenderness; costovertebral angle pain or tenderness and at least 1 of the following findings:

a. positive dipstick for leukocyte esterase and/or nitrite

b. pyuria (urine specimen with ≥10 WBC/mm3 of unspun urine or >5 WBC/high power field of spun urine

c. microorganisms seen on Gram’s stain of unspun urine

 

And a positive urine culture of ≥103 and <105 CFU/ml with no more than 2 species of microorganisms.

 

1.3 Patient ≤1 year of age with or without an indwelling urinary catheter

 

  • Patient has one of the following: fever (>38°C core); hypothermia (<36°C core); apnea; bradycardia; dysuria; lethargy; vomiting and a positive urine culture of ≥105 CFU/ml with no more than 2 species of microorganisms. all criterion must occur within a time frame that does not exceed a gap of 1 calendar day.

 

  • Patient has one of the following : fever (>38°C core); hypothermia (<36°C core); apnea; bradycardia; dysuria; lethargy; vomiting and at least 1 of the following findings:

a)      +ve test for leukocyte esterase and/or nitrite using dipstick.

b)      pyuria (urine specimen with ≥10 WBC/mm3 of unspun urine or >5 WBC/high power field of spun urine

c)      microorganisms on Gram’s stain of unspun urine

 

And a positive urine culture of ≥103 and <105 CFU/ml with no more than 2 species of microorganisms.

 

Asymptomatic Bacteremic UTI 

Patient with or without an indwelling urinary catheter has no signs or symptoms (i.e., for any age patient, no fever (>38°C); urgency; frequency; dysuria; supra-pubic tenderness; costovertebral angle pain or tenderness OR for a patient ≤1 year of age; no fever (>38°C core); hypothermia (<36°C core); apnea; bradycardia; dysuria; lethargy; or vomiting) and a positive urine culture of ≥1o5 CFU/ml with no more than 2 species and a positive blood culture with at least 1 matching uropathogen microorganism to the urine culture, or two  matching blood cultures withdrawn on separate occasions if the matching pathogen is a common skin commensal.

 

Other Urinary Tract Infection 

 

  • Patient with isolated organism from culture of fluid (other than urine) or tissue from affected site.
  • Patient has abscess or other infection evidence  seen on direct examination, during an invasive procedure, or during a histopathologic examination.
  • Patient has at least 2 of the following signs or symptoms: fever (>38°C), localized pain, or localized tenderness at the involved site and at least 1 of the following:
  • i)        purulent drainage from affected siteii)      microorganisms cultured from blood that are compatible with suspected site of infectioniii)    Imaging test evidence of infection (e.g., abnormal ultrasound, CT scan, MRI, or radiolabel scan [gallium, technetium]).
  • Patient <1 year of age has at least 1 of the following signs or symptoms: fever (>38°C core), hypothermia (<36°C core), apnea, bradycardia, lethargy, or vomiting and at least 1 of the following:
  • i)        purulent drainage from affected siteii)      microorganisms cultured from blood that are compatible with suspected site of infectioniii)    Imaging test infection evidence , (e.g., abnormal US , CT scan, MRI, or radiolabel scan [gallium, technetium]).
  • The above clinical symptoms has to have no other recognized cause 

Reference

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