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PubMedDate not supplied

UTI in patients with urethral catheters: an audit tool.

This article presents an audit tool for the evaluation of practice relating to urinary tract infection in hospital patients with indwelling urethral catheters. It has been formulated primarily because urinary tract infection is a known complication of catheterization, and because studies have shown practitioners' knowledge in this area to be poor. Although health professionals have an obligation to ensure their practice is evidence based, this requires substantial time and skills in critical appraisal. The standard presented here is based on evidence from an extensive literature review on how best to minimize urinary tract infection during catheter insertion, meatal hygiene and management of the drainage system. The audit tool offers the potential for improved practice and demonstration of clinical effectiveness through measurable reduction in rates of urinary tract infection. Moreover, it provides an ideal opportunity for nurses to take the lead in clinical audit activity, which is so often medically led. The supplementary information will also provide a useful guide for nurses to undertake and initiate clinical audit activity in the future.

Catheters, Indwelling↗
PubMedDate not supplied

Audit of catheter-associated UTI using silver alloy-coated Foley catheters.

Catheter-associated urinary tract infection (CAUTI) is the most common and most costly healthcare-associated infection, and possibly the most preventable (Salgado et al, 2003). The Cochrane Review of silver alloy-coated Foley catheters concluded that they are successful at reducing the rate of this healthcare-associated infection, which can be potentially fatal (Brosnahan et al, 2004). This article discusses the merits of using the silver alloy-coated Foley catheter in reducing the risk of CAUTI in an acute general hospital. A pre- and post-intervention design was used to audit CAUTI rates. During the pre-intervention period of 10 weeks, the Trust's standard catheters were used and CAUTI rates captured. Silver alloy-coated Foley catheters were introduced and their use monitored for a further period of 10 weeks. A total of 117 newly catheterized patients were actively monitored for signs and symptoms of CAUTI. The audit met and exceeded its aim of reducing the CAUTI rate by 20&. The CAUTI risk rate and device rate fell during the evaluation period. The use of the silver alloy-coated Foley catheters proved to be cost-effective given the recognized additional costs of CAUTI and prolonged in-patient stay (Plowman et al, 1999). Given the results of this audit it is recommended that the silver alloy-coated Foley catheter be the catheter of choice for use with acute patient admissions requiring short-term catheterization.

Adult↗
PubMedDate not supplied

Acute uncomplicated UTI and E. coli resistance: implications for first-line empirical antibiotic therapy.

BACKGROUND: Uncomplicated urinary tract infection (uUTI) typically affects immunocompetent, anatomically normal women. Escherichia coli (E. coli) accounts for approximately 80% of cases. Given increased E. coli-trimethoprimsulfamethoxazole (TMP-SMX) resistance, practice guidelines advocate first-line alternatives based on local resistance rates above 10%. This paper provides a model incorporating use of a new extended-release formulation of ciprofloxacin, used once daily, to facilitate revision of uUTI treatment policies by managed care organizations (MCOs) and practitioners. METHODS: A cost-minimization model was designed from the MCO perspective, assuming an initial office visit with a urinalysis and empiric, 3-day treatment (TMP-SMX 800/160 mg twice daily or ciprofloxacin XR 500 mg once daily). Persistent infections were assumed to require a second visit. Costs were provided by a major employee health and benefit plan provider; clinical data were based on published information. Five case scenarios were used to compare average treatment costs based on varying E. coli resistance rates to therapy and to identify rates of TMP-SMX resistance where total treatment costs are equal. RESULTS: Using national surveillance resistance data, Case 1 demonstrated average cost savings of 9.59 dollars to 10.21 dollars with ciprofloxacin XR. In Case 2, treatment costs (49.19 dollars) were equal at an E. coli resistance rate of 4.3% for TMP-SMX and 1.0% for ciprofloxacin. Case 3 assumed empiric telephone prescribing, demonstrating that, at 4.3% TMP-SMX resistance, costs are equal for both treatments (4.19 dollars). Case 4 used real-world data on therapy duration, demonstrating that, at 2.8% TMP-SMX resistance, costs are equal for both treatments (54.87 dollars). Case 5 assumed 10% ciprofloxacin-E. coli resistance; at 13.3% TMP-SMX resistance, treatment costs were equal (57.50 dollars). Results from all cases demonstrate that while the per-dose cost of ciprofloxacin XR far exceeds TMP-SMX, average total treatment costs are lower for ciprofloxacin XR at expected local levels of E. coli resistance to TMP-SMX. CONCLUSIONS: The results suggest that in areas where local TMP-SMX E. coli resistance exceeds 10% and resistance to ciprofloxacin remains low, (0.5% to 6%) ciprofloxacin XR is an appropriate alternative to standard empiric treatment. The data provide evidence to MCOs that switching to a more expensive per-dose alternative will not necessarily increase total costs when guideline recommendations are followed. Responsible use of antibiotics for uUTI requires selection and administration of the right dosage of the most suitable antibiotic for an appropriate time period to eliminate pathogens quickly and successfully. The decision to use an alternative first-line therapy for uUTI should be driven by local resistance and susceptibility data--not simply per-dose drug acquisition costs.

Acute Disease↗
PubMed1995

Complicated, recurrent, and geriatric UTI.

If the patient is older or has certain underlying diseases, urinary tract infection can persist or recur, and unusual pathogens may be at work. Consider broader-spectrum coverage and a longer treatment course.

Age Factors↗
PubMed1995

Uncomplicated UTI in young women.

Acute, uncomplicated cystitis and pyelonephritis will readily yield to promptly instituted antimicrobial therapy. First, however, you need to rule out other causes of dysuria, including urethritis and vaginitis.

Adult↗
PubMed1998

Guideline for UTIs cuts office visits, lab and drug costs.

It's not just the big-ticket procedures that reap big savings for providers when it comes to developing clinical guidelines. Group Health Cooperative of Puget Sound is saving about $750,000 each year thanks to a clinical guideline for uncomplicated urinary tract infections in women. Here's the step-by-step details, plus Group Health's algorithm and detailed plans for implementation.

Anti-Infective Agents↗
PubMed1986

Microcomputer surveillance as an aid to rational antibiotic therapy for urinary tract infection (UTI) in general practice.

We report our experience with an inexpensive microcomputer system for the storage and retrieval of susceptibility data on urinary isolates for general practitioners and doctors working in the University of Sheffield Student Health Service. Together with the results from a simple questionnaire into their prescribing habits, we believe that help can be given, enabling practitioners to achieve rational prescribing of antibiotics in their treatment of urinary tract infection.

Anti-Bacterial Agents↗