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Better culturing practices improve diagnosis of inpatient UTIs
Interventions directed toward bettering inpatient culturing practices can improve the diagnosis of urinary tract infections, according to findings published in Infection Control and Hospital Epidemiology.
“Guidelines support the use of urinalysis and/or urine microscopy to help differentiate UTI from asymptomatic bacteriuria,” Abigail L. Carlson, MD, from the division of infectious disease in the department of medicine at Washington University School of Medicine, and colleagues wrote. “However, data on the use of these tests in inpatients are limited.”
Carlson and colleagues sought to find the proportion of isolated urine cultures — cultures without urinalysis or urine microscopy — to determine the frequency of urine cultures performed in the general inpatient population without additional testing for pyuria. They performed a retrospective cohort study at a 1,250-bed academic medical center, evaluating urine cultures from four medical and two surgical wards from 2009-2013 and in the medical and surgical ICUs from 2012-2013. Using the hospital’s informatics database, they abstracted patient and laboratory data and identified catheter-associated UTIs (CAUTIs) in the ICUs by infection prevention surveillance. They assessed predictors of isolated cultures using multivariable logistic regression.
Out of 14,743 urine cultures collected during the study (63.5 cultures per 1,000 patient days), 2,973 (20.2%) were isolated cultures. Infection prevention surveillance identified 61 CAUTIs, with 31 (50.8%) identified by an isolated culture. Independent risk factors associated with isolated urine culture included male sex (adjusted OR [aOR] = 1.22; 95% CI, 1.11-1.35), urinary catheterization (aOR = 2.15%; 95% CI, 1.89-2.46), medical and surgical ICU admission (aOR = 1.72; 95% CI, 1.47-2; aOR = 1.82; 95% CI, 1.51-2.19) and culture sent 1 or more days after admission (1-7 days aOR = 1.91; 95% CI, 1.71-2.12; >7 days aOR = 2.81; 95% CI, 2.37-3.34).
“Our data suggest that interventions aimed at improving culturing practices may result in better diagnosis of inpatient UTIs,” Carlson and colleagues wrote. “Further research is needed on testing practices across institutions, provider-related variables impacting urine culturing practices, and the effects of testing variability on antibiotic usage and clinical outcomes.” – by Savannah Demko
Disclosure: Carlson reports no relevant financial disclosures.