Abstract
BackgroundMany clinical practice guidelines encourage diagnosis and empiric treatment of lower urinary tract infection without laboratory investigation; however, urine culture testing remains one of the largest volume tests in the clinical microbiology laboratory. In this study, we sought to determine if there were specific patient groups to which increased testing was directed. To do so, we combined laboratory data on testing rates with Census Canada sociodemographic data.MethodsUrine culture testing data was obtained from the Calgary Laboratory Services information system for 2011. We examined all census dissemination areas within the city of Calgary and, for each area, testing rates were determined for age and gender cohorts. We then compared these testing rates to sociodemographic factors obtained from Census Canada and used Poisson regression and generalized estimating equations to test associations between testing rates and sociodemographic variables.ResultsPer capita urine culture testing is increasing in Calgary. For 2011, 100,901 individuals (9.2% of all people) received urine cultures and were included in this analysis. The majority of cultures were received from the community (67.9%). Substantial differences in rate of testing were observed across the city. Most notably, urine culture testing was drastically lower in areas of high (≥ $100000) household income (RR = 0.07, p < 0.0001) and higher employment rate (RR = 0.36, p < 0.0001). Aboriginal – First Nations status (RR = 0.29, p = 0.0008) and Chinese visible minority (RR = 0.67, p = 0.0005) were also associated with decreased testing. Recent immigration and visible minority status of South Asian, Filipino or Black were not significant predictors of urine culture testing. Females were more likely to be tested than males (RR = 2.58, p < 0.0001) and individuals aged 15–39 were the most likely to be tested (RR = 1.69, p < 0.0001).ConclusionsConsiderable differences exist in urine culture testing across Calgary and these are associated with a number of sociodemographic factors. In particular, areas of lower socioeconomic standing had significantly increased rates of testing. These observations highlight specific groups that should be targeted to improve healthcare delivery and, in turn, enhance laboratory utilization.
Highlights
Many clinical practice guidelines encourage diagnosis and empiric treatment of lower urinary tract infection without laboratory investigation; urine culture testing remains one of the largest volume tests in the clinical microbiology laboratory
Lower urinary tract infection (LUTI, cystitis) can be reliably diagnosed without laboratory investigation based on a focused history of urinary symptoms in the absence of urethral discharge or vaginal irritation
Data on 225,473 urine culture results were available in our laboratory information system (LIS) for 2011, which represented 133,464 individuals who underwent urine culture testing
Summary
Many clinical practice guidelines encourage diagnosis and empiric treatment of lower urinary tract infection without laboratory investigation; urine culture testing remains one of the largest volume tests in the clinical microbiology laboratory. Adult women with symptomatic, uncomplicated LUTI should receive short-course empiric antibiotic therapy and do not require urinalysis. These recommendations are largely based on the following important considerations. The most common method is reporting of quantitative culture, for which there are established thresholds of bacterial quantity which define clinical significance [3, 5, 10]. Escherichia coli can be associated with symptomatic disease even when isolated at quantities that are orders of magnitude below these thresholds. These combined factors minimize the value of urine culture results in both asymptomatic and symptomatic individuals
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