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Sustained decrease in urine culture utilization after implementing a reflex urine culture intervention: A multicenter quasi-experimental study

Published online by Cambridge University Press:  30 January 2020

Jessica R. Howard-Anderson Open the ORCID record for Jessica R. Howard-Anderson [Opens in a new window] ,
Shanza Ashraf ,
Elizabeth C. Overton ,
Lisa Reif ,
David J. Murphy  and
Jesse T. Jacob
Jessica R. Howard-Anderson*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Shanza Ashraf
Affiliation:
Office of Quality, Emory Healthcare, Atlanta, Georgia
Elizabeth C. Overton
Affiliation:
Office of Quality, Emory Healthcare, Atlanta, Georgia
Lisa Reif
Affiliation:
Emory University Hospital, Atlanta, Georgia
David J. Murphy
Affiliation:
Office of Quality, Emory Healthcare, Atlanta, Georgia Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Jesse T. Jacob
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
*
Author for correspondence: Jessica Howard-Anderson, E-mail: Jrhowa4@emory.edu
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Extract

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.

Type
Research Brief
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 3 , March 2020 , pp. 369 - 371
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: A preliminary version of this work was presented at the Society to Improve Diagnosis in Medicine Annual International Conference on November 5, 2018, in New Orleans, Louisiana.

References

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