Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home residents

J Am Geriatr Soc. 2007 Jul;55(7):1072-7. doi: 10.1111/j.1532-5415.2007.01217.x.

Abstract

Objectives: To prospectively evaluate nursing home residents with suspected urinary tract infection (UTI) to determine whether they met the McGeer, Loeb, or revised Loeb consensus-based criteria and whether any set of criteria was associated with laboratory evidence of UTI, namely bacteriuria (>100,000 colony forming units) plus pyuria (>10 white blood cells).

Design: Prospective cohort study.

Setting: Three New Haven-area nursing homes.

Participants: Of 611 residents screened, 457 were eligible, 362 consented, and 340 enrolled.

Measurements: Participants underwent prospective surveillance from May 2005 to April 2006 for the development of suspected UTI (defined as a participant's physician or nurse clinically suspecting UTI). One hundred participants with suspected UTI and a urinalysis and urine culture performed were included in the analyses.

Results: Participants were identified who met the criteria of McGeer, Loeb, revised Loeb, and laboratory evidence of UTI. Using laboratory evidence of UTI as the outcome, the McGeer criteria demonstrated 30% sensitivity, 82% specificity, 57% positive predictive value (PPV), and 61% negative predictive value (NPV); the Loeb criteria showed 19% sensitivity, 89% specificity, 57% PPV, and 59% NPV; and the revised Loeb criteria demonstrated 30% sensitivity, 79% specificity, 52% PPV, and 60% NPV.

Conclusion: All of the consensus-based criteria have similar test characteristics. The diagnostic accuracy of UTI criteria in nursing home residents could be improved, and the data suggest that evidence-based clinical criteria associated with laboratory evidence of UTI need to be identified and validated.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Diagnostic Techniques, Urological / standards*
  • Female
  • Follow-Up Studies
  • Homes for the Aged*
  • Humans
  • Inpatients*
  • Male
  • Nursing Homes*
  • Population Surveillance
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Time Factors
  • Urinary Tract Infections / diagnosis*
  • Urinary Tract Infections / epidemiology