IF the patient is > 65 years of age, fever alone, without a localizing UTI sign/symptom, cannot be used as an element when an indwelling urinary catheter is not in place in an inpatient location > 2 days on the date of event. 1A, B, and C. Can I use positive cultures reported as 75-100,000 CFU/ml to meet the UTI definition? Q5: I have a patient that had a positive urine culture with 100,000 CFU/ml of E. coli and then, within the repeat infection time frame (RIT), another urine culture that had greater than 100,000 CFU/ml of K. pneumoniae and E. faecium. Q15: My facility changes indwelling urinary catheters from bed bags to leg bags so that our patients can attend physical therapy.

Additionally, the blood specimen must have a collection date within the UTI secondary BSI attribution period. Can either of these cultures be used to meet the UTI criteria, or because there are more than 3 organisms in the UTI RIT, would they be excluded?

Even within a single species there can be substantial variation. Normal flora of the GI/GU tract. Normal Actions Should these be included in CAUTI surveillance since the system is not “closed”?

In the presence of a positive urine culture which may have been collected as a differential diagnosis for suspicion of UTI it would be very rare that there is another associated cause for urinary urgency, urinary frequency and dysuria which are hallmark UTI symptoms. The strength of lactobacillus products is usually indicated by the number of living organisms per capsule. The genomes of Lactobacillus are highly variable, ranging in size from 1.2 to 4.9 Mb (megabases). Q12: Would NHSN accept low back pain to describe costovertebral pain? Identifying Healthcare-associated Infections, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), FAQs About NHSN Agreement to Participate and Consent, Enrollment for Ambulatory Surgery Centers, Enrollment for Acute Care Hospitals/Facilities, Enrollment for Long-term Acute Care Hospitals/Facilities, Enrollment for Inpatient Rehabilitation Facilities, Enrollment for Inpatient Psychiatric Facilities, Enrollment for Outpatient Dialysis Facilities, Data Dashboard – Hospital Capacity Snapshot, Data Dashboard – Change in 14 Day Period, Archived Patient Safety COVID-19 Module Documents, Surveillance for Same Day Outcome Measures, Surveillance for Healthcare Personnel Vaccination, Surveillance for Antimicrobial Use and Antimicrobial Resistance Options, Surveillance for C. difficile, MRSA, and other Drug-resistant Infections, Surveillance for Healthcare Personnel Exposure, Long-term Acute Care Hospitals/Facilities, Increasing LTCF SAMS Level Access to NHSN, Surveillance for C. difficile Infection (CDI) and Multidrug Resistant Organisms (MDRO), Surveillance for Urinary Tract Infections (UTI), Surveillance for Prevention Process Measures – Hand Hygiene, Gloves and Gown Use Adherence, Surveillance for HCP and Resident Vaccination, Frequently Asked Questions About Dialysis Event Reporting, Surveillance for Dialysis Patient Influenza Vaccination, Surveillance for Dialysis Healthcare Personnel Vaccination, Pediatric Ventilator-Associated Events (PedVAE), HCP Influenza Vaccination Summary Reporting FAQs, Inpatient Rehabilitation Facilities (IRF), CDC and CMS Issue Joint Reminder on NHSN Reporting, Facility/Provider Communications Under HIPAA, Biovigilance Component Protocol April 2018, Healthcare Personnel Safety Component Manual March 2020, 2020 Outpatient Procedure Component Manual, 2019 Outpatient Procedure Component Manual, U.S. Department of Health & Human Services, Date(s) of indwelling urinary catheter insertion/removal if applicable, Collection date(s) and results of urine cultures including colony count, Collection date(s) and results of any positive blood cultures, UTI signs/symptoms (fever >38.0°C, suprapubic tenderness*, costovertebral angle pain or tenderness*, urinary urgency^, urinary frequency^, dysuria^).

Scenario 1 of the Secondary BSI guide (Appendix B of the BSI protocol pdf icon[PDF – 1 MB]) states: At least one organism from the blood specimen must match an organism identified from the site-specific infection, in this case, the urine, that is used as an element to meet the NHSN site-specific infection criterion. Q6: Is there a time period following the identification of a UTI during which another UTI cannot be reported? Do not add multiple cultures together.

An indwelling urinary catheter in place could cause patient complaints of “frequency” “urgency” or “dysuria”.

We determined the genotypic identification of >100 Lactobacillus isolates from clinical specimens in the context of presumed pathogenic potential (e.g., recovered as the single/predominant isolate from a sterile site or at ≥105 CFU/ml from urine). Surveillance criteria may not be equally sensitive for all patient populations.

Lactobacillus, which is a common vaginal contaminant in women’s urine samples, will appear as thin purple (gram-positive) rods. No this urine culture is not eligible for use in an NHSN UTI determination. Only catheter-associated UTI data (both ABUTI and SUTI) are shared with CMS. The 50,000 CFU/ml MRSA is not used as an element in the UTI definition. What information is needed to assist with UTI determination?

For women Lactobacillus species can also be considered a biomarkers and agent that can promote various aspects of vaginal health. If they cannot, and you cannot say for certain that a culture has at least 100,000 CFU/ml, because it is reported as 75,000-100,000 CFU/ml, do not use that culture for NHSN UTI surveillance. Q11: Can these symptoms be used on the same day when the indwelling urinary catheter was removed and reinserted?

Antimicrobial susceptibility results nor colony morphology difference does not equate to a report of separate organisms. ... > 170 species are known.
If no UTI was associated with that urine culture, then the second urine culture could be considered for UTI, since no previous UTI RIT was set and there were not more than 2 organisms in that urine culture.

Lactobacillus, which is a common vaginal contaminant in women’s urine samples, will appear as thin purple (gram-positive) rods. Patient populations in which the UTI criteria may not be as sensitive include spinal cord injury patients, those with brain injuries, and heavily sedated patients.

Though rare, some lactobacilli that have been involved in UTI development are L. gasseri and L. delbrueckii. • 75k-100,000 CFU/ml

Some of the bacteria, such as Lactobacillus, are easy for an experienced laboratorian to identify, are nonpathogenic, and do not require any further investigation. (Please reference SUTI 1b protocol pdf icon[PDF – 1 MB] on page 7-6).

Significant Bacteriuria: Lactobacillius in urine at a heightened level must be demonstrated through various tests in order to properly diagnose this disorder.
• >100,000 CFU/ml.

Q18: When the colony count of an eligible UTI pathogen does not meet the requirement for use in meeting the UTI definition, can I still use that pathogen to attribute a BSI with matching pathogen to the UTI event?

Please see the information on Repeat Infection Timeframe found in the chapter 2 “Identifying Healthcare-associated Infections pdf icon[PDF – 1 MB]” in the NHSN manual.

Clinical decision about “with no other recognized cause” for the UTI signs/symptoms of suprapubic tenderness or costovertebral angle pain or tenderness should be made by the person performing NHSN UTI surveillance in your organization who has access to the entire medical record and clinical picture. The E.coli #1 and #2 is considered one organism, similarly Enterococcus species #1 and Enterococcus species #2 would be considered one organism.

Urinary retention is not considered the same as dysuria and cannot be used to meet the UTI definition.

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