Reduction In Urine Cultures Research Articles

Impact of Urine Culture Reflex Policy Implementation in a Large County Hospital Inpatient Rehabilitation Unit-A Pilot Study.

To promote antimicrobial stewardship, many institutions have implemented a policy of reflexing to a urine culture based on a positive urinalysis result. The rehabilitation patient population, including individuals with brain and spinal cord injuries, may have atypical presentations of urinary tract infections. The study objective is to determine the effects of implementing a urine culture reflex policy in this specific patient population. In an inpatient rehabilitation unit, 348 urinalyses were analyzed from August 2019 to June 2021. Urinalysis with greater than or equal to 10 white blood cells per high power field was automatically reflexed to a urine culture in this prospective study. Primary outcome was return to acute care related to urinary tract infection. Secondary outcomes included adherence to reflex protocol, antibiotic utilization and appropriateness, adverse outcomes related to antibiotic use, and reduction in urine cultures processed and the associated reduction in healthcare costs. There was no statistically significant difference before and after intervention related to the primary outcome. Urine cultures processed were reduced by 58% after intervention. Urine culture reflex policy is likely an effective intervention to reduce the frequency of urine cultures without significantly affecting the need to transfer patients from inpatient rehabilitation back to the acute care setting.

Impact of restrictive urinalysis reflex to culture criteria at a large community hospital

Treatment of asymptomatic bacteriuria (ASB) is a common, but often unnecessary, practice. Our objective was to determine the impact of restrictive urinalysis reflex to culture (UARC) criteria on rate of urine cultures (UC) ordered and ASB treatment. Criteria were modified from positive leukocyte esterase, positive nitrites, or white blood cells (WBC) >10 cells to only WBC >10 cells.This pre-post study evaluated UARCs ordered in the emergency department or inpatient units. The primary outcome was the proportion of reflex UCs prevented. Secondary outcomes included the frequency of repeat UARCs and stand-alone UCs, gram-negative rod (GNR) bacteremia, and ASB treatment.In the pre-intervention, there were 4761 UARCs compared to 5420 in the post-intervention; 37.9 % and 21.4 % reflexed to UCs, a 43.5 % reduction in UCs. The rate of repeat UARCs, stand-alone UCs, and GNR bacteremia in the pre- and post-interventions were similar. ASB treatment rate was numerically lower in the post-intervention.

Reducing inappropriate urine cultures through a culture standardization program

The objective of this study was to evaluate the impact of a urine culture standardization program that included order indications and urinalysis (U/A) with reflexive culture. The program applied to all adult and pediatric inpatients at an academic medical center; emergency department and ambulatory clinic patients were excluded. The analysis compared outcomes in the pre-implementation (January 2015-May 2016) and post-implementation (July 2016-September 2017) periods. The primary outcomes were urine culture and U/A orders per 1,000 patient days, catheter-associated urinary tract infection (CAUTI) rate per 1,000 catheter days, and urine culture contamination rate per 1,000 patient days. Catheter standardized utilization ratios (SURs) were also examined. The intervention was associated with a significant decrease in urine culture rates by 6.9 cultures per 1,000 patient days (95% CI -4.44, -9.44; P < .0001). The U/A testing rate per 1,000 patient days significantly increased pre-intervention, was not affected acutely by the intervention institution, and significantly decreased post-implementation. The CAUTI rate was not significantly changed by the intervention but did significantly increase post-implementation by 0.2 per 1,000 catheter days (95% CI 0.01, 0.47; P = .04); SURs significantly decreased (0.03; 95% CI -0.003, -0.05; P = .03); and the urine culture contamination rate per month showed no significant change. Sixty-four percent of urine cultures ordered using the reflexive test did not reflex to culture by U/A criteria. A urine culture standardization program led to a significant reduction in urine cultures and did not lead to an increase in U/A testing rates. CAUTI rates increased post-implementation, which may have been confounded by reduced catheter utilization.

185 Impact of Eliminating a Urinalysis With Reflex to Urine Culture on Urine Testing Patterns in the Emergency Department

As antibiotic resistance has increased as a public health threat, attention has focused on interventions aimed at reducing unnecessary antibiotic prescribing. This includes the overtreatment of asymptomatic bacteriuria (ASB), due to unnecessary urine testing with subsequent diagnosis of urinary tract infection (UTI) despite absence of clinical symptoms. With ASB common in some populations, such as older adults, stewardship programs should seek to reduce unnecessary urine testing on asymptomatic patients. A reflex urinalysis (UA) (defined as WBC> 5/hpf = urine culture) order is commonly used in the emergency department (ED) setting due to perceived operational efficiency benefits; however, this can result in unnecessary diagnosis and treatment of UTI. The objective of the study was to evaluate the impact of removing reflex UA from the computerized physician order entry system (CPOE) on overall urine testing patterns in an academic ED. We conducted a retrospective study of all patients who received any urine test in the ED within the six month pre- and post-intervention periods. A one-month washout period was used surrounding reflex UA removal. The intervention consisted of a notification to providers via e-mail who frequently used reflex UA (academic detailing) and removal of reflex UA from personal and ED preference lists and order sets (systems approach). A positive culture was defined as growth of one or more pathogenic organisms at 104 CFU/ml or greater. Patient demographic and urine testing data were extracted from the electronic health record and analyzed using STATA SE15. Primary outcomes were the rates of total cultures and contaminated cultures per 1000 ED visits. Patient safety was assessed by analysis of any missed urine cultures in pyelonephritis or urosepsis cases. Urine culture cost was estimated from the Medicare Clinical Laboratory Fee Schedule. The study included 17,061 patients with 20,029 urine tests (mean age, 45.7 years; 85.0% white; 60.8% female). The six-month average urine culture order rate fell from 63.2 per 1000 ED visits to 35.3 per 1000 post-intervention, a 41% overall reduction (P<0.001). The rate of contaminated cultures was 16.0 per 1000 ED visits before the intervention compared to only 6.9 after (P<0.001) (see Figure). Of those diagnosed with pyelonephritis or sepsis, 72.8% received a urine culture before intervention in contrast to 56.9% after intervention (P<0.001). Cost savings from reduction in urine cultures was estimated to be $10,830. Removal of reflex UA from the CPOE led to significant reductions in the rates of total cultures performed as well as contaminated cultures. However, there was also a significant decrease in urine cultures obtained for conditions where a culture is typically recommended. Ordering systems greatly impact urine testing practices and could have future implications in reducing overtreatment of ASB. Any intervention or change to eliminate reflex UA orders should be accompanied with robust provider education emphasizing the need to separately order urine cultures when indicated.

Elimination of Screening Urine Cultures Prior to Elective Joint Arthroplasty.

Discontinuing routine processing of screening urine cultures prior to elective joint arthroplasty resulted in substantial reduction in urine cultures ordered and antimicrobial prescriptions for asymptomatic bacteriuria, without any significant impact on incidence of prosthetic joint infection. This simple change would be scalable across institutions with potential for significant healthcare savings.

Evaluación del citómetro UF-1000i como método de cribado en el diagnóstico de infecciones del tracto urinario

IntroductionThe urine culture is a huge workload in the Microbiology Laboratory and remains the gold standard for the diagnosis of urinary tract infections. Considering the high prevalence of negative results, the implementation of a reliable screening method could lead to cost saving in the workload, and speed up reporting of negative results. MethodsWe evaluated the usefulness of the flow cytometer UF-1000i in the screening for negative samples than could be excluded from culture. We divided the samples into two groups, Group1, males and women of childbearing age who were considered positive with a growth ≥104CFU/ml, and Group2, considered positive with ≥105CFU/ml growth. ResultsOn comparing the culture and screening data in the ROC curve, the best sensitivity and specificity points were 53.1bact/μl for Group1, and 128.3bact/μl for Group2. In Group1, the sensitivity was 92.2% and a specificity of 60%, a reduction in urine cultures of 46%, with 2.1% false negative (42samples). In Group2, the sensitivity was 86%, with a specificity of 87.7%, a culture reduction of 57.5%, and 5.1% false negatives (74samples). ConclusionThe incorporating of the UF-1000i cytometer to the screening of urine samples depends on the characteristics of the patients and the definition of positive urine culture. In our case, with only studying bacteriuria, the data on the reduction of workload and the false negatives seriously question this incorporation.

Screening for Urinary Tract Infection with the Sysmex UF-1000i Urine Flow Cytometer

The diagnosis of urinary tract infection (UTI) by urine culture is time-consuming and can produce up to 60 to 80% negative results. Fast screening methods that can reduce the necessity for urine cultures will have a large impact on overall turnaround time and laboratory economics. We have evaluated the detection of bacteria and leukocytes by a new urine analyzer, the UF-1000i, to identify negative urine samples that can be excluded from urine culture. In total, 1,577 urine samples were analyzed and compared to urine culture. Urine culture showed growth of ≥10(3) CFU/ml in 939 samples (60%). Receiver operating characteristics (ROC) curves and ROC decision plots were been prepared at three different gold standard definitions of a negative urine culture: no growth, growth of bacteria at <10(4) CFU/ml, and growth of bacteria at <10(5) CFU/ml. Also, the reduction in urine cultures and the percentage of false negatives were calculated. At the most stringent gold standard definition of no growth, a chosen sensitivity of 95% resulted in a cutoff value of 26 bacteria/μl, a specificity of 43% and a reduction in urine cultures of only 20%, of which 14% were false negatives. However, at a gold standard definition of <10(5) CFU/ml and a sensitivity of 95%, the UF-1000i cutoff value was 230 bacteria/μl, the specificity was 80%, and the reduction in urine cultures was 52%, of which 0.3% were false negatives. The applicability of the UF-1000i to screen for negative urine samples strongly depends on population characteristics and the definition of a negative urine culture. In our setting, however, the low workload savings and the high percentage of false-negative results do not warrant the UF-1000i to be used as a screening analyzer.