Effects of the Implementation of Reflexive Urine Cultures on Antibiotic Utilization in Hospitalized Patients

Abstract

Primary Endpoints ♦ Numbers of Ucx collected and results preand post-intervention ♦ Duration of continuous antibiotic (abx) therapy from time of UA +/Ucx in hospitalized inpatients up to 7 days ♦ Total days of abx from time of UA +/Ucx in hospitalized inpatients up to 7 days Secondary Endpoints ♦ UTI diagnoses, C diff toxin assay + Experimental Design Retrospective, observational, single-center study ♦ Analysis period: Pre-intervention, February 2013-July 2013. Postintervention, September 2013-February 2014. ♦ Data obtained from UCM Clinical Research Data Warehouse Inclusion criteria ♦ Pre-intervention: all Ucx sent, ED or hospitalized ♦ Post-intervention: UA with reflex Ucx, or Ucx exemption (Fig 1) Statistical analysis ♦ Primary and Secondary outcomes: Descriptive statistics  The implementation of reflexive Ucx based on presence of pyuria on UA resulted in less Ucx being performed.  Reflexive Ucx use did not result in a decrease in overall mean total antibiotic days in hospitalized inpatients or in the subset of midstream collection within 7 days of test.  However, evaluating for mean continuous antibiotic duration after Ucx alone, there was a significant decrease in duration of therapy, both in all inpatients and in those whose samples were collected by midstream catch.  Overall CA-UTI rates decreased during this time period, and this intervention was part of a bundle of interventions aimed at decreasing CA-UTI rates.  There was not a significant decrease in C. diff diagnoses.  The reflexive Ucx policy at UCM did result in a statistically significant decrease in continuous antibiotic duration, but this is not likely clinically significant given that both durations are less than one day.