Abstract
Objective: To assess the impact of changing the reporting threshold policy of positive urine cultures in hospitalized non-pregnant adults from 104 CFU/mL to 105 CFU/mL on the unwarranted use of antibiotics and patient safety. Setting: A 1100-bed tertiary-care hospital in southern Israel. Methods: As an intervention, we changed urine culture reporting policy for patients admitted to general medical wards. If culture grew ≥105 CFU/mL, it was reported with pathogen and antibiotic susceptibility data, if it grew ≤104 CFU/mL, it was reported as “low growth". The withheld information was available upon request. We retrospectively collected data on all patients in a four-month period following the intervention and report using STROBE guidelines. Results: 7808 patients were admitted, in whom 3523 urine cultures were obtained. A total of 496 grew a pathogen, 51 were excluded (candida spp. positive, history of urinary surgery, obtained from catheter). A total of 300 were reported as positive and 145 were reported as low-growth. A higher rate of patients in the low-growth group were not treated with antibiotics 45/145(31%) vs. 56/300(18.7%) in the positive group p = 0.015 and the antibiotic duration of treatment was shorter by day 5 (IQR 0.9) vs. 6 (IQR 0.9) p = 0.015. No between-group difference was observed in recurrent admission rates, pyelonephritis within 30 days, bacteremia or all-cause mortality. Conclusions: Changing the reporting threshold of positive urine culture results from 104 CFU/mL to 105 CFU/mL in hospitalized patients reduced the number of patients who were unnecessarily treated for asymptomatic bacteriuria without negatively impacting patient safety. We urge microbiological laboratories to consider this change in threshold as part of an antimicrobial stewardship program.
Reference16 articles.
1. Williams, B.A., Chang, A., Ahalt, C., Chen, H., Conant, R., Landefeld, C.S., Ritchie, C., and Yukawa, M. (2014). Current Diagnosis & Treatment: Geriatrics, McGraw-Hill Education. [2nd ed.].
2. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of Americaa;Nicolle;Clin. Infect. Dis.,2019
3. Suprapubic Bladder Aspiration in Diagnosis of Urinary Tract Infection;Bailey;BMJ,1969
4. Voided Midstream Urine Culture and Acute Cystitis in Premenopausal Women;Hooton;N. Engl. J. Med.,2013
5. Effectiveness of Preanalytic Practices on Contamination and Diagnostic Accuracy of Urine Cultures: A Laboratory Medicine Best Practices Systematic Review and Meta-analysis;LaRocco;Clin. Microbiol. Rev.,2016
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献