ABSTRACT
OBJECTIVES: We wanted to assess the diagnostic accuracy of urinary dipstick testing in excluding catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients with fever or hypothermia. METHODS: This was a prospective observational cohort study in a medical-surgical ICU. Patients with new-onset fever >38.3 °C or hypothermia <36 °C at least 48 h after urinary catheter insertion were included over a 2-year period. At each episode, a urinary dipstick test and a urine culture were performed as the criterion standard. Extensive microbiological investigations for extra-urinary infections were performed also. The performances of various urinary dipstick result combinations in ruling out CAUTI were compared based on the likelihood ratios (LR+ and LR-). RESULTS: Symptomatic CAUTI was diagnosed in 31 (24.4 %) of the 127 included patients (195 episodes of fever or hypothermia). LR+ was best for combined leukocyte esterase-positive and nitrite-positive dipstick results (overall population: 14.91; 95 % confidence interval [95 % CI], 5.53-40.19; patients without urinary symptoms: 15.63; 95 % CI, 5.76-42.39). LR- was best for either leukocyte esterase-positive or nitrite-positive dipstick results (overall population: 0.41; 95 % CI, 0.57-0.65; patients without urinary symptoms, 0.36; 95 % CI, 0.21-0.60). CONCLUSIONS: Urinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia.
Subject(s)
Catheter-Related Infections/diagnosis , Fever of Unknown Origin/etiology , Hypothermia/etiology , Point-of-Care Systems , Urinary Tract Infections/diagnosis , Urine/chemistry , Adult , Carboxylic Ester Hydrolases/analysis , Cohort Studies , Female , Humans , Intensive Care Units , Male , Microbiological Techniques , Middle Aged , Nitrites/analysis , Prospective Studies , Urine/microbiologySubject(s)
Dyspnea/etiology , Fever/etiology , Leptospirosis/diagnosis , Meningitis/etiology , DNA, Bacterial/blood , DNA, Bacterial/cerebrospinal fluid , Doxycycline/therapeutic use , Humans , Leptospira/genetics , Leptospira/immunology , Leptospira/isolation & purification , Leptospirosis/complications , Leptospirosis/drug therapy , Leptospirosis/microbiology , Meningitis/cerebrospinal fluid , Meningitis/microbiology , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Bacterial/microbiology , Tomography, X-Ray Computed , Water MicrobiologySubject(s)
Capillary Leak Syndrome/diagnosis , Shock, Septic/diagnosis , Ventricular Dysfunction, Left/etiology , Capillary Leak Syndrome/complications , Capillary Leak Syndrome/therapy , Cardiovascular Agents/therapeutic use , Combined Modality Therapy , Diagnosis, Differential , Emergencies , Fatal Outcome , Female , Fluid Therapy , Humans , Hypotension, Orthostatic/etiology , Middle Aged , Monoclonal Gammopathy of Undetermined Significance/complications , Multiple Myeloma/genetics , POEMS Syndrome/diagnosis , Pasteurella Infections/complications , Pasteurella multocida , Respiration, Artificial , Skin Diseases, Bacterial/complicationsABSTRACT
INTRODUCTION: Leptospirosis is a rare cause of alveolar haemorrhage. The diagnosis is often delayed particularly when the mode of infection is atypical. These serious complications require prompt antibiotic treatment. CASE REPORT: A 21-year-old man was involved in a road accident and found lying unconscious in a roadside ditch containing stagnant water. Ten days later he presented with bilateral interstitial pneumonia and rapidly increasing hypoxaemia associated with cholestasis and liver cell necrosis. Broncho-alveolar lavage revealed alveolar haemorrhage. There was satisfactory resolution following antibiotic therapy. CONCLUSIONS: The diagnosis of leptospirosis was considered initially despite negative serology (Martin and Petit) and confirmed by sero-conversion 20 days after the onset of symptoms.