Anne Rebecca Fabiny, M.D.
|Title||Assistant Professor of Medicine|
|Institution||Cambridge Health Alliance|
|Address||Cambridge Health Alliance|
Department of Medicine, Geriatrics Division
1493 Cambridge St
Cambridge MA 02139
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Available: 09/19/11, Expires: 09/19/21
1. Identify the most common uropathogens causing symptomatic cystitis in patient > 65 years of age
2. Determine prevalence of antimicrobial resistance
3. Understand risk factors that predispose patients to infection with extended-spectrum beta-lactamase (ESBL) producing bacteria
4. Determine optimal antibiotic selection for this population
A prospective surveillance study will be conducted in patients > 65 yr of age presenting to the Cambridge Health Alliance geriatrics ambulatory practices and Emergency Department who meet the definition of a symptomatic UTI defined as presenting with any of the following symptoms: dysuria, frequency, urgency, suprapubic pain, confusion, new or worsened incontinence or lethargy and a positive urine culture (>100,000 colony forming units/mL) with pyuria (>5 leukocytes/high power field on urinalysis). Urine samples will be collected by mid-stream clean catch or by catheterization for culture, sensitivity and microscopic analysis. Samples will be processed according to routine laboratory methodology.
A case control study will be performed in order to identify risk factors for infection with an ESBL producing organism. Age, sex, ethnicity, residence, weight, (functional status ?), indwelling bladder catheter, hospitalization within the past year, antibiotic treatment within preceding 3 mos (drugs, dose, duration), comorbidities (DM, cancer, neurogenic bladder, BPH, immunosuppression, renal insufficiency (Clcr), nephrolithiasis, urologic abnormalities, etc.), catheterization within the past three months, bacterial pathogen accounting for current infection, and bacteria documented in urine cultures in the preceding 12 mo will be entered into a database. Univariate and multivariate logistic regression will be performed to identify risks for ESBL infection.
The prevalence of fluoroquinolone, trimethoprim-sulfamethoxazole, oral beta-lactams and nitrofurantoin resistance will be determined.
Results from this prospective study will inform practitioners about the susceptibility profile of uropathogens in this patient population and identify risk factors for infection with an ESBL-producing organism which may warrant consideration for parenteral therapy. An antibiogram will be developed for treating culture proven cystitis in outpatients older than 65.
The student will be the project manager, overseeing collection of data, maintaining the database and work in partnership with a statistician (presumably available through HMS), as well as collaborate with the CHA Microbiology Laboratory to develop a susceptibility report for patients included in this study. The student will particpate in developing an Antibiogram for this patient population.
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