790. Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections?: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Urinary tract infection (UTI) is a commonly misdiagnosed infectious condition. Stewardship interventions which successfully reduce rates of asymptomatic bacteriuria treatment (ASB) are often labor intensive, and thus a systematic solution is desirable. In this study, our objective was to systematically review studies to evaluate the effect of implementing a clinical decision support system on the ordering of urine culture tests for the diagnosis of UTI across diverse clinical settings. Methods We conducted a comprehensive electronic search of 5 databases and manual reference list review for peer-reviewed articles published prior to July 2, 2021. Studies which described an intervention designed to reduce unnecessary or incorrect diagnosis of UTI through utilization of CDS were included. The primary outcome of interest was rate of urine culture tests ordered. Two investigators independently screened studies and extracted and compiled data. Results A total of 5,013 studies were screened, of which 14 met inclusion criteria for the systematic review (Table 1). The most common intervention was urinalysis with reflex to urine culture based on pre-specified urinalysis parameters, such as a threshold level of pyuria. All 9 studies with statistical comparisons reported a decreased urine culture rate post-intervention, 8 of which were statistically significant (Table 2). Overall, a 37% decrease in urine culture rate was detected after CDS implementation (Table 3). Several studies also reported improvements in antimicrobial-related measures such as days of therapy and guideline-concordant therapy. Catheter-associated urinary tract infection rate was decreased in 2 studies and unchanged in 1 study. A limited number of included studies reported no adverse outcomes including increased bloodstream infection and mortality rates. Conclusion Electronic clinical decision support systems appear to be effective in decreasing unnecessary urine culture tests and improving UTI diagnosis. Prospective studies are needed to evaluate the impact on antimicrobial prescribing, patient-relevant outcomes, and potential adverse effects. Disclosures Elie Saade, MD, MPH, Janssen: Advisor/Consultant Curtis Donskey, MD, Pfizer, Clorox, Ecolab, and Professional Disposables International: Grant/Research Support Abhishek Deshpande, MD, PhD, Clorox: Grant/Research Support|Merck & Co., Inc., Kenilworth, NJ, USA: Advisor/Consultant|Merck & Co., Inc., Kenilworth, NJ, USA: Stocks/Bonds|Seres Therapeutics: Grant/Research Support.