大家可以看一下国外CAUTI监测定义的解释，从中可以体验监测定义与临床诊断的区别！！

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大家可以看一下国外CAUTI监测定义的解释，从中可以体验监测定义与临床诊断的区别！！！

Definitions, criteria and recognition（定义、诊断标准、识别）

Before you start conducting CAUTI surveillance, you must decide which criteria you will use to define CAUTI. Ideally, you should use standardized definitions, such as those developed by the Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC). The criteria used include signs and symptoms the HCW looks for, and laboratory tests to consider. The CDC and ECDC definitions of CAUTI have some differences; their application influences whether a patient is considered to have a CAUTI—which in turn will impact treatment decisions. We will explain more on the challenges this presents next.

在开始进行 CAUTI 监测之前，您必须决定使用哪些标准来定义 CAUTI。理想情况下，您应该使用标准化定义，例如由疾病控制与预防中心 （CDC） 和欧洲疾病预防与控制中心 （ECDC） 制定的定义。使用的标准包括 HCW 寻找的体征和症状，以及要考虑的实验室检查。CDC 和 ECDC 对 CAUTI 的定义存在一些差异;它们的应用会影响患者是否被认为患有 CAUTI，这反过来又会影响治疗决策。接下来，我们将详细解释这带来的挑战。

1、CDC Definition of CAUTI
CDC对CAUTI的定义

Patient must meet criteria 1, 2, and 3 below:
患者必须满足以下标准 1、2 和 3：

• Patient had an indwelling urinary catheter that had been in place for over two calendar days (in the inpatient location) on the date of event AND was either:
  患者在感染事件发生之日留置导尿管已放置超过两个日历日（在住院地点），并且是：
  
  • present for any portion of the calendar day on the date of event
    在感染日的有导尿管
    OR
  • removed the day before the date of event.
    在感染日前一天拔出导尿管。
    
• Patient has at least one of the following signs or symptoms:
  患者至少有以下一种体征或症状：
  
  • fever (> 38.0°C): to use fever in a patient aged over 65 years of age, the indwelling urinary catheter needs to be in place for more than two calendar days on date of event;
    发烧（> 38.0°C）：65 岁以上患者发烧时，留置导尿管需要在感染事件发生之日放置两个日历日以上;
  • tenderness above the pubic bone (with no other recognized cause);
    耻骨以上压痛（无其他公认病因）;
  • pain/tenderness in the area of the back overlying the kidneys (with no other recognized cause);
    肾脏上方背部区域疼痛/压痛（无其他公认原因）;
  • urinary urgency (cannot be used when catheter is in place);
    尿急（有导尿管时不适用）;
  • urinary frequency (cannot be used when catheter is in place);
    尿频（有导尿管时不适用）;
  • painful or difficult urination (cannot be used when catheter is in place).
    排尿疼痛或排尿困难（有导尿管时不适用）。
    
• Patient has a urine culture with no more than two species of organism identified, at least one of which is a bacterium of ≥ 105 CFU/mL (colony-forming unit).
  患者进行尿培养，鉴定出不超过两种微生物，其中至少一种是≥ 105 CFU/mL（菌落形成单位）的细菌。
  

2、ECDC Definitions of UTI
ECDC对UTI的定义

UTI-A: Microbiologically Confirmed Symptomatic UTI
UTI-A：微生物学证实的症状性尿路感染

• Patient has at least one of the following signs of symptoms with no other recognized cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness; and
  患者至少有以下症状之一，没有其他公认原因：发热（> 38 °C）、尿急、尿频、排尿困难或耻骨上压痛;和
• patient has a positive urine culture—that is, ≥ 105 microorganisms per mL of urine with no more than two species of microorganisms.
  患者尿培养呈阳性，即每 mL 尿液≥ 105 种微生物，微生物不超过两种。
  

UTI-B: Not Microbiologically Confirmed Symptomatic UTI
UTI-B：未经微生物学证实的症状性尿路感染

• Patient has at least two of the following with no other recognized cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness; and
  患者至少有以下两种症状，且没有其他公认的病因：发热（> 38 °C）、尿急、尿频、排尿困难或耻骨上压痛;和
• at least one of the following:
  至少满足以下条件之一：
  
  • positive dipstick for leukocyte esterase and/or nitrate;
    白细胞酯酶和/或硝酸盐试纸阳性;
  • pyuria urine specimen with ≥ 10 WBC/mL or ≥ 3 WBC/high-power field of unspun urine; organisms seen on Gram stain of unspun urine;
    脓尿尿标本，≥ 10 WBC/mL 或 ≥ 3 WBC/高倍未旋转尿液;在未旋转尿液的革兰氏染色上看到的生物体;
  • at least two urine cultures with repeated isolation of the same uropathogen (Gram-negative bacteria or S. saprophyticus) with ≥ 102 colonies/mL urine in nonvoided specimens;
    至少两次尿培养，重复分离相同的尿路病原体（革兰氏阴性菌或腐生链球菌），在未排尿标本中≥ 102 个菌落/mL 尿液;
  • ≤ 105 colonies/mL of a single uropathogen (Gram-negative bacteria or S. saprophyticus) in a patient being treated with effective antimicrobial agent for a urinary infection;
    在接受有效抗菌剂治疗泌尿系统感染的患者中，≤ 105 个菌落/mL 的单个尿路病原体（革兰氏阴性菌或腐生链球菌）;
  • physician diagnosis of a urinary tract infection; and/or
    医生诊断尿路感染;和/或
  • physician institutes appropriate therapy for a urinary infection.
    医生对泌尿系统感染进行适当的治疗。
    
  
  

UTI-C: Asymptomatic Bacteriuria
UTI-C：无症状菌尿

Patient has no fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness and either of the following criteria:
患者没有发热（> 38 °C）、尿急、尿频、排尿困难或耻骨上压痛以及以下任一标准：

• patient has had an indwelling urinary catheter within seven days before urine is cultured, and
  患者在尿培养前 7 天内留置导尿管，并且
• patient has a urine culture, that is, ≥ 105 microorganisms per mL of urine with no more than two species of microorganisms;
  患者进行尿培养，即每毫升尿液≥ 105 种微生物，微生物不超过两种;
• patient has not had an indwelling urinary catheter within seven days before the first positive culture; and
  患者在首次阳性培养前 7 天内未留置导尿管;和
• patient has had at least two positive urine cultures ≥ 105 microorganisms per mL of urine with repeated isolation of the same microorganism and no more than two species of microorganisms.
  患者至少有两次尿培养阳性，≥每毫升尿液中含有 105 种微生物，并重复分离相同的微生物和不超过两种微生物。
  

3、Comparing Definitions—Challenges in Recognizing CAUTI
比较定义——识别 CAUTI 的挑战

There is no international agreement on definitions used in the surveillance of CAUTI, but the CDC and ECDC definitions have both been validated and are the most commonly used.
关于CAUTI监测中使用的定义没有统一的国际标准，但CDC和ECDC的定义都已经过验证，并且是最常用的定义。

CDC: Because the CDC definition requires a positive culture result, it is challenging to use in settings with no laboratory. Unlike the ECDC definition, the CDC definition states that the indwelling urinary catheter must have been in place for at least two days before the onset of symptoms for a diagnosis of CAUTI to be made.
CDC：由于 CDC 定义要求培养结果呈阳性，因此在没有实验室的环境中使用具有挑战性。与 ECDC 定义不同，CDC 定义指出，留置导尿管必须在症状出现前至少放置两天才能诊断为 CAUTI。

ECDC: The ECDC definition has advantages in that it enables a diagnosis to be made without the need for microbiology laboratory support—i.e., using a urine dipstick test. It is interesting to note that this definition can be applied to identify CAUTI if a urinary catheter is present and in situ within seven days of the onset of signs and symptoms.
ECDC：ECDC定义的优点在于，它可以在不需要微生物学实验室支持的情况下做出诊断，即使用尿液试纸测试。有趣的是，如果在体征和症状出现后 7 天内存在导尿管且原位存在导尿管，则该定义可用于识别 CAUTI。

Both definitions emphasize that you must not consider asymptomatic bacteriuria as a UTI.
这两个定义都强调，您不得将无症状菌尿视为尿路感染。

The challenge is to decide on a definition that is agreed upon and consistently applied within your facility. Be sure to engage hospital management to agree upon which definition to use, and to use a multimodal strategy to ensure staff are aware of and use that definition in their daily practice.
挑战在于确定一个在您的医疗机构中达成一致并始终如一地应用的定义。确保与医院管理层就使用哪个定义达成一致，并使用多模式策略来确保员工在日常实践中了解并使用该定义。

Note: The important thing to remember is that deciding on a definition that is used by all staff at your facility will allow for the most consistent and accurate measurement of CAUTI.
注意：要记住的重要一点统一使用定义是对 CAUTI 进行最一致和最准确的测量。

These standardized definitions from the CDC and ECDC are important in determining the true burden of infection. Patients with long-term catheters will often have high concentrations of bacteria in the urine without having an infection (asymptomatic bacteriuria). The presence of bacteria alone is not a reliable indicator for infection; it does not differentiate between colonization and infection.
CDC和ECDC的这些标准化定义对于确定真正的感染负担非常重要。长期使用导尿管的患者通常尿液中会有高浓度的细菌，而没有感染（无症状菌尿）。细菌的存在本身并不是感染的可靠指标;它不区分定植和感染。

4、Surveillance Definition Versus Clinical Diagnosis
监测定义与临床诊断

Surveillance definitions are used for a different purpose than those used in the context of clinical diagnosis. Surveillance definitions involve the use of standardized criteria that surveillance staff or researchers can use to study and identify trends in a population (i.e., for epidemiological rather than clinical purposes). In some situations, a clinical diagnosis is influenced by the symptoms a patient displays and may be made even when the surveillance definition is not met. However, in the special case of CAUTI it is important to establish the presence of infection, applying standardized criteria, before starting any treatment.

监测定义与临床诊断使用的目的是不同的。监测定义涉及使用标准化标准，监测人员或研究人员可以使用这些标准来研究和确定人群趋势（即，用于流行病学而不是临床目的）。在某些情况下，临床诊断受患者症状的影响，即使不符合监测定义，也可能做出临床诊断。然而，在CAUTI的特殊情况下，在开始任何治疗之前，应用标准化标准确定感染的存在是很重要的。