A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit

Robert T. Stovall, James B. Haenal, Timothy C. Jenkins, Gregory Jurkovich, Fredric M. Pieracci, Walter L. Biffl, Carlton C. Barnett, Jeffrey L. Johnson, Denis D. Bensard, Ernest E. Moore, Clay Cothren Burlew

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Urinary tract infection (UTI) in trauma patients is associated with increased mortality. Whether the urinalysis (UA) is an adequate test for a urinary source of fever in the ICU trauma patient has not been demonstrated. We hypothesized that the UA is a valuable screen for UTI in the febrile, critically ill trauma patient. Study Design: All trauma ICU patients in our surgical ICU who had a fever (temperature >38.0 C), urinary catheter, UA, and a urine culture between January 1, 2011 and December 13, 2011 were reviewed. A positive UA was defined as positive leukocyte esterase, positive nitrite, WBC > 10/high power field, or presence of bacteria. A positive urine culture was defined as growth of ≥105 colony forming units (cfu) of an organism irrespective of the UA result or ≥103 cfu in the setting of a positive UA. A UTI was defined as positive urine culture without an alternative cause of the fever. Results: There were 232 UAs from 112 patients that met criteria. The majority (75%) of patients were men; the mean age was 40 (±16) years. Of the 232 UAs, 90 (38.7%) were positive. There were 14 UTIs. The sensitivity, specificity, positive predictive value, and negative predictive value of the UA for UTI were 100%, 65.1%, 15.5%, and 100%, respectively. Conclusions: A negative UA reliably excludes a catheter-associated UTI in the febrile, trauma ICU patient with a 100% negative predictive value, and it can rapidly direct the clinician toward more likely sources of fever and reduce unnecessary urine cultures.

Original languageEnglish (US)
Pages (from-to)162-166
Number of pages5
JournalJournal of the American College of Surgeons
Volume217
Issue number1
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

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Catheter-Related Infections
Urinalysis
Urinary Tract Infections
Intensive Care Units
Fever
Wounds and Injuries
Urine
Stem Cells
Urinary Catheters
Nitrites
Critical Illness
Bacteria
Sensitivity and Specificity
Temperature
Mortality
Growth

ASJC Scopus subject areas

  • Surgery

Cite this

A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit. / Stovall, Robert T.; Haenal, James B.; Jenkins, Timothy C.; Jurkovich, Gregory; Pieracci, Fredric M.; Biffl, Walter L.; Barnett, Carlton C.; Johnson, Jeffrey L.; Bensard, Denis D.; Moore, Ernest E.; Cothren Burlew, Clay.

In: Journal of the American College of Surgeons, Vol. 217, No. 1, 01.07.2013, p. 162-166.

Research output: Contribution to journalArticle

Stovall, RT, Haenal, JB, Jenkins, TC, Jurkovich, G, Pieracci, FM, Biffl, WL, Barnett, CC, Johnson, JL, Bensard, DD, Moore, EE & Cothren Burlew, C 2013, 'A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit', Journal of the American College of Surgeons, vol. 217, no. 1, pp. 162-166. https://doi.org/10.1016/j.jamcollsurg.2013.02.030
Stovall, Robert T. ; Haenal, James B. ; Jenkins, Timothy C. ; Jurkovich, Gregory ; Pieracci, Fredric M. ; Biffl, Walter L. ; Barnett, Carlton C. ; Johnson, Jeffrey L. ; Bensard, Denis D. ; Moore, Ernest E. ; Cothren Burlew, Clay. / A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit. In: Journal of the American College of Surgeons. 2013 ; Vol. 217, No. 1. pp. 162-166.
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abstract = "Background: Urinary tract infection (UTI) in trauma patients is associated with increased mortality. Whether the urinalysis (UA) is an adequate test for a urinary source of fever in the ICU trauma patient has not been demonstrated. We hypothesized that the UA is a valuable screen for UTI in the febrile, critically ill trauma patient. Study Design: All trauma ICU patients in our surgical ICU who had a fever (temperature >38.0 C), urinary catheter, UA, and a urine culture between January 1, 2011 and December 13, 2011 were reviewed. A positive UA was defined as positive leukocyte esterase, positive nitrite, WBC > 10/high power field, or presence of bacteria. A positive urine culture was defined as growth of ≥105 colony forming units (cfu) of an organism irrespective of the UA result or ≥103 cfu in the setting of a positive UA. A UTI was defined as positive urine culture without an alternative cause of the fever. Results: There were 232 UAs from 112 patients that met criteria. The majority (75{\%}) of patients were men; the mean age was 40 (±16) years. Of the 232 UAs, 90 (38.7{\%}) were positive. There were 14 UTIs. The sensitivity, specificity, positive predictive value, and negative predictive value of the UA for UTI were 100{\%}, 65.1{\%}, 15.5{\%}, and 100{\%}, respectively. Conclusions: A negative UA reliably excludes a catheter-associated UTI in the febrile, trauma ICU patient with a 100{\%} negative predictive value, and it can rapidly direct the clinician toward more likely sources of fever and reduce unnecessary urine cultures.",
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AU - Haenal, James B.

AU - Jenkins, Timothy C.

AU - Jurkovich, Gregory

AU - Pieracci, Fredric M.

AU - Biffl, Walter L.

AU - Barnett, Carlton C.

AU - Johnson, Jeffrey L.

AU - Bensard, Denis D.

AU - Moore, Ernest E.

AU - Cothren Burlew, Clay

PY - 2013/7/1

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N2 - Background: Urinary tract infection (UTI) in trauma patients is associated with increased mortality. Whether the urinalysis (UA) is an adequate test for a urinary source of fever in the ICU trauma patient has not been demonstrated. We hypothesized that the UA is a valuable screen for UTI in the febrile, critically ill trauma patient. Study Design: All trauma ICU patients in our surgical ICU who had a fever (temperature >38.0 C), urinary catheter, UA, and a urine culture between January 1, 2011 and December 13, 2011 were reviewed. A positive UA was defined as positive leukocyte esterase, positive nitrite, WBC > 10/high power field, or presence of bacteria. A positive urine culture was defined as growth of ≥105 colony forming units (cfu) of an organism irrespective of the UA result or ≥103 cfu in the setting of a positive UA. A UTI was defined as positive urine culture without an alternative cause of the fever. Results: There were 232 UAs from 112 patients that met criteria. The majority (75%) of patients were men; the mean age was 40 (±16) years. Of the 232 UAs, 90 (38.7%) were positive. There were 14 UTIs. The sensitivity, specificity, positive predictive value, and negative predictive value of the UA for UTI were 100%, 65.1%, 15.5%, and 100%, respectively. Conclusions: A negative UA reliably excludes a catheter-associated UTI in the febrile, trauma ICU patient with a 100% negative predictive value, and it can rapidly direct the clinician toward more likely sources of fever and reduce unnecessary urine cultures.

AB - Background: Urinary tract infection (UTI) in trauma patients is associated with increased mortality. Whether the urinalysis (UA) is an adequate test for a urinary source of fever in the ICU trauma patient has not been demonstrated. We hypothesized that the UA is a valuable screen for UTI in the febrile, critically ill trauma patient. Study Design: All trauma ICU patients in our surgical ICU who had a fever (temperature >38.0 C), urinary catheter, UA, and a urine culture between January 1, 2011 and December 13, 2011 were reviewed. A positive UA was defined as positive leukocyte esterase, positive nitrite, WBC > 10/high power field, or presence of bacteria. A positive urine culture was defined as growth of ≥105 colony forming units (cfu) of an organism irrespective of the UA result or ≥103 cfu in the setting of a positive UA. A UTI was defined as positive urine culture without an alternative cause of the fever. Results: There were 232 UAs from 112 patients that met criteria. The majority (75%) of patients were men; the mean age was 40 (±16) years. Of the 232 UAs, 90 (38.7%) were positive. There were 14 UTIs. The sensitivity, specificity, positive predictive value, and negative predictive value of the UA for UTI were 100%, 65.1%, 15.5%, and 100%, respectively. Conclusions: A negative UA reliably excludes a catheter-associated UTI in the febrile, trauma ICU patient with a 100% negative predictive value, and it can rapidly direct the clinician toward more likely sources of fever and reduce unnecessary urine cultures.

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