Open AccessSustained decrease in urine culture utilization after implementing a reflex urine culture intervention: A multicenter quasi-experimental study
Author(s) -
Jessica HowardAnderson,
Shanza Ashraf,
Elizabeth Overton,
Lisa Reif,
David J. Murphy,
Jesse T Jacob
Publication year - 2020
Publication title -
infection control and hospital epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.243
H-Index - 138
eISSN - 1559-6834
pISSN - 0899-823X
DOI - 10.1017/ice.2020.5
Subject(s) - pyuria , urinalysis , medicine , urine , urinary system , bacteriuria , intensive care medicine , asymptomatic , intervention (counseling) , reflex , asymptomatic bacteriuria , antimicrobial stewardship , pediatrics , antibiotics , antibiotic resistance , psychiatry , microbiology and biotechnology , biology
Accurately diagnosing urinary tract infections (UTIs) in hospitalized patients remains challenging, requiring correlation of frequently nonspecific symptoms and laboratory findings. Urine cultures (UCs) are often ordered indiscriminately, especially in patients with urinary catheters, despite the Infectious Diseases Society of America guidelines recommending against routine screening for asymptomatic bacteriuria (ASB).1,2 Positive UCs can be difficult for providers to ignore, leading to unnecessary antibiotic treatment of ASB.2,3 Using diagnostic stewardship to limit UCs to situations with a positive urinalysis (UA) can reduce inappropriate UCs since the absence of pyuria suggests the absence of infection.4-6 We assessed the impact of the implementation of a UA with reflex to UC algorithm ("reflex intervention") on UC ordering practices, diagnostic efficiency, and UTIs using a quasi-experimental design.