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Safety, effectiveness and sustainability of a laboratory intervention to de-adopt culture of midstream urine samples among hospitalized patients

Published online by Cambridge University Press:  02 September 2020

Mohammad Mozafarihashjin Open the ORCID record for Mohammad Mozafarihashjin [Opens in a new window] ,
Jerome A. Leis ,
Lorraine Maze dit Mieusement ,
Liz McCreight ,
Susan Poutanen ,
Ananya Shrivastava ,
Jannice So ,
Christine Soong ,
Liz van Horne  and
Louis Wong
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Mohammad Mozafarihashjin
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Jerome A. Leis
Affiliation:
Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
Lorraine Maze dit Mieusement
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
Liz McCreight
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
Susan Poutanen
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Ananya Shrivastava
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
Jannice So
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
Christine Soong
Affiliation:
Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada Division of General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada Centre for Quality and Patient Safety, University of Toronto, Toronto, Ontario, Canada
Liz van Horne
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
Louis Wong
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
Allison McGeer*
Affiliation:
Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
*
Author for correspondence: Dr. Allison McGeer, E-mail: allison.mcgeer@sinaihealth.ca
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Abstract

Objective:

To assess the safety, sustainability, and effectiveness of a laboratory intervention to reduce processing of midstream urine (MSU) cultures.

Design:

Prospective observational cohort.

Setting:

Medical and surgical inpatients in a tertiary-care hospital.

Participants:

The study included 1,678 adult inpatients with an order for MSU culture.

Methods:

From 2013 to 2019, ordered MSU cultures were not processed unless the laboratory was called. Patients were interviewed on days 0 and 4; from 2017 to 2019, day-30 follow-up was added. Primary outcome was serious adverse events due to not processing MSU cultures. Secondary outcomes were nonserious adverse events due to not processing MSU cultures, rates of MSU cultures submitted, proportion of MSU cultures processed, proportion of patients prescribed urinary tract infection (UTI)–directed antibiotics, and laboratory workload.

Results:

Among 912 and 459 patients followed to days 4 and 30, respectively, no serious adverse events attributable to not processing MSU cultures were identified. However, 6 patients (0.66%) had prolonged urinary symptoms potentially associated with not processing MSU cultures. We estimated that 4 patients missed having empiric antibiotics stopped in response to negative MSU cultures, and 99 antibiotic courses for asymptomatic bacteriuria (ASB) and 8 antibiotic-associated adverse events were avoided. The rate of submitted MSU samples and proportion of patients receiving empiric UTI-directed antibiotics did not change. The proportion of MSU cultures processed declined from 59% to 49% (P < .0001), and total laboratory workload was reduced by 185 hours.

Conclusions:

De-adopting the processing of MSU cultures from medical and surgical inpatient units is safe and sustainable, and it reduces antibiotic prescriptions for ASB at a cost of prolonged urinary symptoms in a small proportion of patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 1 , January 2021 , pp. 43 - 50
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

[Present affiliations: Infection Prevention and Control, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (L.M.M); Regional Municipality of York, Newmarket, Ontario, Canada (J.S.); Public Health Agency of Canada, Toronto, Ontario, Canada (L.W.)]

PREVIOUS PRESENTATION. Preliminary data from this research study were presented as a poster at the IDWeek 2019 conference on October 4th, 2019, in Washington, DC.

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