Abstract
Objectives: To assess the predictive value of the urinalysis (UA) reflex criteria’s parameters and to evaluate the criteria’s impact on antimicrobial usage
 Methods: A prospective study using laboratory data was conducted on inpatient urine samples with orders placed for Urinalysis Reflex Culture (UARC) in a 400-bed acute care hospital. A total of 4016 urine samples were collected and examined between February and April 2020. The UA results were then subjected to the laboratory UA reflex criteria for reflecting UA to culture. Multivariable logistic regression was utilized in evaluating the effectiveness of the criteria’s parameters to predict positive urine cultures
 Results: The total number of the positive UA reflex samples was 1539, which accounted for 38.3% of all the UA samples. Moreover, those positive UA samples were reflexed to urine cultures. Among the urine samples that were cultured, 45.1% (n = 694) were negative urine cultures while 54.9% (n = 845) were positive urine cultures. The UA reflex criterion was associated with positive predictive values for positive urine cultures between 26.30% and 92.96%.
 Conclusions: The current Laboratory UA reflex criterion is not highly effective in predicting positive urine culture, thus potentially leading to the inappropriate antimicrobial usage.
Highlights
Antimicrobial resistance (AR) is a serious threat to the treatment of infectious diseases, which might result in human side effects, loss of life, and huge economic impacts
The UA reflex criteria was associated with positive predictive values for positive urine cultures between 26.30% and 92.96%
Urine samples were collected from patients who presented to the hospital for routine workup or possible urinary tract infections (UTIs) but not necessarily with any signs or symptoms
Summary
Antimicrobial resistance (AR) is a serious threat to the treatment of infectious diseases, which might result in human side effects, loss of life, and huge economic impacts. Laboratories play a vital role in the prevention of the spread of AR [1]. The microbiology laboratory can rapidly detect AR pathogens and inform treating physicians and infection control practitioners to help prevent the spread and protect other patients (CDC 2018). Urinary tract infections (UTIs) are one of the leading conditions that require antibiotics intervention, contributing highly to antibiotic misuse [2]. Patients presented with the possibility of having urinary tract infection (UTI) are often screened by urinalysis (UA) to determine whether administration of antibiotics is warranted and whether a urine culture is needed. Improper urinalysis reflex criteria can result in suboptimal laboratory practice and can incorrectly influence healthcare practitioners to inappropriately prescribe antibiotics [3,4]
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