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{
    "pk": 12404,
    "title": "Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly",
    "subtitle": null,
    "abstract": "Introduction:\n Routine interventions in the practice of medicine often lack definitive evidence or are based on evidence that is either not high quality or of only modest-to-marginal effect sizes. An abnormal urinalysis in an elderly patient presenting to the emergency department (ED) with non-specific symptoms represents one condition that requires an evidence-informed approach to diagnosis and management of either asymptomatic bacteriuria or urinary tract infection (UTI). The emergency provider often will not have access to urine cultures, and the risks associated with antibiotic use in the elderly are not without potentially significant side effects.\nMethods:\n We performed a historical and clinical review of the growing body of literature suggesting measurable differences in the systemic immune response manifest among patients with asymptomatic pyuria and UTI, including increases in the pro-inflammatory cytokine interleukin-6 and the acute phase reactant procalcitonin.\nResults:\n Serum procalcitonin, a peptide that undergoes proteolysis into calcitonin, has been demonstrated to quickly and reliably rise in patients with severe bacterial infections, and may serve as a potentially sensitive and specific marker for identification of bacterial illness.\nConclusion:\n In the absence of validated risk scores for diagnosing UTI in elderly patients presenting to the ED, there may be a role for the use of procalcitonin in this patient population.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Procalcitonin, Asymptomatic Bacteriuria, UTI, Geriatrics, Elderly"
        }
    ],
    "section": "Geriatrics",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3f30h732",
    "frozenauthors": [
        {
            "first_name": "Richard",
            "middle_name": "",
            "last_name": "Pescatore",
            "name_suffix": "",
            "institution": "Crozer-Keystone Health System, Department of Emergency Medicine, Upland, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Joshua",
            "middle_name": "D.",
            "last_name": "Niforatos",
            "name_suffix": "",
            "institution": "Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of Emergency Medicine Cleveland, Ohio",
            "department": "None"
        },
        {
            "first_name": "Salim",
            "middle_name": "",
            "last_name": "Rezaie",
            "name_suffix": "",
            "institution": "Greater San Antonio Emergency Physicians, Department of Emergency Medicine, San Antonio, Texas",
            "department": "None"
        },
        {
            "first_name": "Anand",
            "middle_name": "",
            "last_name": "Swaminathan",
            "name_suffix": "",
            "institution": "St. Joseph’s Regional Medical Center, Department of Emergency Medicine, Paterson, New Jersey",
            "department": "None"
        }
    ],
    "date_submitted": "2018-12-27T18:27:09Z",
    "date_accepted": "2018-12-27T18:27:09Z",
    "date_published": "2019-06-11T19:43:25Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/12404/galley/6597/download/"
        }
    ]
}