2111. Changing the Culture: A Quasi-Experimental Study Assessing the Burden of Urine Cultures and the Impact of Stewardship of Testing in an Urban Community Hospital

Abstract

BackgroundIndwelling urinary catheters (IUC) may cause inflammation and colonization, decreasing the diagnostic yield of urinalysis and urine cultures (UC). Indiscriminate testing can lead to misinterpretation of positive results as a catheter associated urinary tract infection (CAUTI), increasing antibiotic use and CAUTI rates. We studied the burden of UC and implemented a UC stewardship initiative (UCSI) as part of a comprehensive CAUTI reduction program.MethodsA retrospective review of cases with IUC and positive UC in 2014 was performed. UCSI was implemented in March 2017 (Figure 1). Nursing staff were instructed to contact the infectious diseases physician when UC from IUC were ordered. Cases were reviewed and, if no UC indication based on IDSA guidelines was met, cultures were discontinued after conferring with ordering physician. Twelve months pre- and post-intervention data were collected; including case description, catheter days, UC ordered, alternative cause of fever, and recommendations.ResultsThe pre-USCI cohort had 23 UC in 19 cases. One UC (4%) met indication (Figure 2). Three (16%) met NHSN criteria for CAUTI and did not meet UC indication. The USCI cohort had 21 UC orders in 13 cases. Most UC did not meet indication and were cancelled (90%, 19/21). Alternative causes for fever were found in all cases with cancelled UC orders (19/19), including pneumonitis, pneumonia, pancreatitis and tuberculosis. Antimicrobials were used in 53% (7/13). UC orders per hospitalization ranged 1–4 (average 1.7). IUC days ranged from 3 to 18 days (average 8). In both cohorts, UC with indication (3) did not meet NHSN criteria for CAUTI and did not receive antimicrobials.Figure 1.UCSI Implementation.Figure 2.Characteristics of cohorts pre and post-USCI.ConclusionPatients with IUC frequently underwent UC without evidence-based indications. This may lead clinicians down the wrong diagnostic path and contribute to antimicrobial use. Critically ill patients with inflammatory conditions are at high risk of UC testing. USCI is a cost-effective intervention that reduced indiscriminate testing, antibiotic use and CAUTIs. USCI can play an important role in CAUTI prevention strategies and antibiotic stewardship programs.Disclosures All authors: No reported disclosures.