Sunday , August 14 2022

The hospital halves urine cultures by encouraging urinalysis renewal tests


David K. Warren, MD, FIDSA, FSHEA

David K. Warren

An intervention involving the change of the electronic ordering system to encourage urinalysis renewal tests for suspected urinary tract infections led to a 45% reduction in urine cultures that had been ordered at St. Louis without losing any UTI, according to research published in Infection Control & & Hospital Epidemiology.

"Over-testing for UTIs drives healthcare costs and leads to unnecessary antibiotic use, which spreads antibiotic collision," David K. Warren, MD, The MPH, The says a medicine medicine in the split of infectious diseases at Washington University School of Medicine and a hospital epidemiologist at Barnes-Jewish Hospital, in St Louis, in a news release.

"Booking tests when the patient need them is a good thing. But unsolicited ordering tests do not waste resources and can unwantly respect patients."

Warren and colleagues both changed to the way urine tests were carried out at Barnes-Jewish Hospital. As explained in the new statement, clinicians were emailed to explain the logic for a dipstick urine test for signs of UTI before ordering a bacterial culture. They also changed the electronic ordering system to make urineware – and not a culture – the default test, leaving clinicians the option of ordering a culture test order itself if they wanted it, even though they opened an additional screen on their computers.

For their study, Warren and colleagues included adults who had at least one urine culture performed during their stay. They compare urine culture rates from January 2015 to April 2016 – before the 1 month intervention held in April 2016 – to rates from May 2016 to August 2017, after the intervention.

Warren and colleagues said that 18,954 patients (median age, 62, 52.3% of women) had ordered 24,569 urine cultures; 27% of cultures were positive. According to the findings, there was a significant reduction in the rate of urine culture during the post-intervention period for any type of samples compared to the pre-observation period (38.1 per 1,000 days of a patient 20.9 per 1,000 patients), clean payment (30.0 against 18.7) and catheter urine (7.8 against 1.9; P <.001, all). They also noted that urine culture rates have decreased for all types of sample when a series of time series models were used.

"By urging clinicians to use urinalysis recovery tests, rather than urine cultures for hospital patients, we have significantly reduced the number of urine cultures performed among these patients," said Warren Infectious Disease News. "At the same time, we did not see any changes in catheter-related UTI rates, suggesting we did not lose UTI."


Warren added that the study demonstrates the importance of how computerized recording systems have been planned.

"Our study shows that relatively small changes in these systems can have a major impact on testing habits, which can limit unnecessary tests and use of unnecessary antibiotics," he said. – – by Bruce Thiel

Disclosures: The authors do not report any relevant financial disclosures.

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