Skip to main content
×
Home

Downstream Impact of Urine Cultures Ordered without Indication at Two Acute Care Teaching Hospitals

  • Jerome A. Leis (a1), Wayne L. Gold (a1), Nick Daneman (a2), Kaveh Shojania (a3) and Allison McGeer (a1) (a4)...
Abstract

Antimicrobial therapy for asymptomatic bacteriuria (ASB) is recommended for pregnant patients and those undergoing genitourinary procedures. In other populations, treatment has not been demonstrated to confer benefit and is associated with adverse drug reactions, selection for infection with increasingly drug-resistant bacteria, and Clostridium difficile infection. We undertook a prospective audit of urine culture ordering practices among medical and surgical inpatients at 2 acute care teaching hospitals to identify the proportion of urine cultures ordered without clinical indication that lead to antimicrobial therapy for ASB.

During August and September 2012, consecutive urine cultures from nonpregnant ward patients were identified within 24 hours of culture ordering. Each patient was interviewed by the study team to determine the presence of urinary tract infection (UTI) using standard surveillance criteria. Non-catheterized patients met clinical indications for UTI if they had fever (temperature >38°C) without another explanation or at least 1 urinary symptom (dysuria, urgency, frequency, costovertebral angle tenderness, or suprapubic pain or tenderness). Catheterized patients met clinical indications for UTI if they had fever, suprapubic pain, or costovertebral angle tenderness. Other reasons for ordering cultures were documented on the basis of care provider interviews before culture results were known. Culture results and antimicrobial prescriptions were documented 72 hours later. The study was approved by the research ethics boards of Mount Sinai Hospital (472 beds) and University Health Network (408 beds; Toronto General Hospital site).

Copyright
Corresponding author
200 Elizabeth Street, 13EN-213, University Health Network, Toronto, Ontario M5G 2C4, Canada (jerome.leis@mail.utoronto.ca)
References
Hide All
1.Nicolle LE, Bradley S, Colgan R, et al.Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40(5):643654.
2.Nicolle L, Mayhew J, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med 1987;83:2733.
3.Cai T, Mazzoli S, Mondaini N, et al.The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis 2012;55(6):771777.
4.Rotjanapan P, Dosa D, Thomas KS. Potentially inappropriate treatment of urinary tract infections in two Rhode island nursing homes. Arch Intern Med 2011;171(5):438443.
5.Lin E, Bhusal Y, Horwitz D, Shelburne SA, Trautner BW. Over-treatment of enterococcal bacteriuria. Arch Intern Med 2012;172(1):3338.
6. Centers for Disease Control and Prevention; National Healthcare Safety Network. Surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting, http://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. 2013. Accessed April 2013.
7.Linares LA, Thornton DJ, Strymish J, Baker E, Gupta K. Electronic memorandum decreases unnecessary antimicrobial use for asymptomatic bacteriuria and culture-negative pyuria. Infect Control Hosp Epidemiol 2011;32(7):644648.
8.Bonnal C, Baune B, Mion M, et al.Bacteriuria in a geriatric hospital: impact of an antibiotic improvement program. J Am Med Dir Assoc 2008;9(8):605609.
9.Loeb M, Brazil K, Lohfeld L, et al.Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomized controlled trial. BMJ 2005;331(7518):669.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 91 *
Loading metrics...

Abstract views

Total abstract views: 391 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st November 2017. This data will be updated every 24 hours.