scholarly journals Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center

2017 ◽  
Vol 38 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Abigail L. Carlson ◽  
Satish Munigala ◽  
Anthony J. Russo ◽  
Kathleen M. McMullen ◽  
Helen Wood ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Laboratory Data ◽  
Surgical Intensive Care ◽  
Tertiary Referral Center ◽  
Patient Admissions ◽  
Academic Medical ◽  
Tract Infections

OBJECTIVETo describe the frequency of urine cultures performed in inpatients without additional testing for pyuriaDESIGNRetrospective cohort studySETTINGA 1,250-bed academic tertiary referral centerPATIENTSHospitalized adultsMETHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.Infect Control Hosp Epidemiol2017;38:455–460

Real-World Experience Using Cefpodoxime and Cefuroxime Axetil for Urinary Tract Infections at a Large Academic Medical Center

2020 ◽  
Vol 29 (1) ◽  
pp. e27-e31
Author(s):  
Hongkai Bao ◽  
Shin-Pung Jen ◽  
Xian Jie (Cindy) Chen ◽  
Justin Siegfried ◽  
Vinh P. Pham ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Real World ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cefuroxime Axetil ◽  
Academic Medical ◽  
Tract Infections

scholarly journals 58. Evaluation of a Disease State Stewardship Intervention for Urinary Tract Infections at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S50-S50
Author(s):  
Xhilda Xhemali ◽  
Derek W Forster ◽  
Bryant Clemons ◽  
Sarah Cotner ◽  
Jeremy VanHoose ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Guideline Adherence ◽  
Medical Center ◽  
Academic Medical Center ◽  
State Intervention ◽  
Disease State ◽  
Audit And Feedback ◽  
Academic Medical ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are often misdiagnosed and mismanaged. Disease state stewardship initiatives targeting UTIs may have a significant impact on the overuse of antimicrobials (ABX). The purpose of our study is to evaluate the effectiveness of a UTI focused disease state stewardship intervention. Methods This retrospective study was conducted at a tertiary care academic medical center. Patients > 18 years of age with a collected urinalysis (UA) and receiving ABX for a UTI were included. Retrospective review of UTI management from 9–11/2017 was performed and used as the baseline. In the post-intervention period, 9–11/2018, the UTI management guideline had been published and service lines educated. A prospective audit and feedback (PAAF) initiative was started 6/2019, whereby the antimicrobial stewardship team performed daily reviews of patients on ABX for UTIs. Patients reviewed 9–11/2019 were included in the PAAF cohort. Exclusion criteria included: pregnancy, undergoing a urologic procedure, treatment of a concomitant infection, receiving therapy based on outside recommendations, or left AMA/expired during treatment. The primary outcome of this study was to evaluate overall guideline adherence. Results 600 patients (200 in each group) were included, with 419 (69.8%) female and an overall median age of 61.4 years. Altered mental status (24.8%) and dysuria (21.5%) were the two main diagnostic testing indications. Treatment of asymptomatic presentations decreased between the three periods, 74.0% vs 48.5% vs 36.0%. Appropriate ordering of UA (33.5% vs 55.0% vs 68.5%, p< 0.001) and urine cultures (29.0% vs 57.1% vs 64.8%, p< 0.001) improved following guideline implementation and PAAF. Interventions by the stewardship team were made in 21% of patients during PAAF, namely therapy discontinuation (78.6%). Overall guideline adherence significantly improved over time, 13.0% vs 27.0% vs 36.5%, p< 0.001. Conclusion UTI disease state intervention was associated with a reduction in the treatment of asymptomatic presentations, increase in appropriate diagnostic ordering, and improvement in overall guideline adherence. PAAF can be a powerful stewardship strategy for promoting consistency in UTI treatment and decreasing unnecessary ABX use. Disclosures All Authors: No reported disclosures

scholarly journals Evaluation of a Disease State Stewardship Intervention for Urinary Tract Infections at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s226-s226
Author(s):  
Xhilda Xhemali ◽  
Derek Forster ◽  
Bryant Clemons ◽  
Sarah Cotner ◽  
Jeremy VanHoose ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Real Time ◽  
Urinary Tract Infections ◽  
Guideline Adherence ◽  
Medical Center ◽  
Academic Medical Center ◽  
Disease State ◽  
Academic Medical ◽  
Before And After ◽  
Tract Infections

Background: Urinary tract infections (UTIs) are often misdiagnosed and mismanaged. Disease state stewardship initiatives targeting UTIs through the development of institutional guidelines and real-time prospective audit and feedback (PAAF) on provider management may have a significant impact on the overuse of antimicrobials. Objective: Our study evaluated the effectiveness of a UTI focused disease state stewardship intervention by assessing institutional guideline adherence before and after implementation. Methods: This retrospective quasi-experimental study was conducted at a tertiary-care academic medical center. Patients >18 years of age receiving antimicrobials for a UTI were included. A previously performed retrospective review of UTI management from September-November 2017 was used as the baseline. The UTI management guideline was implemented in July 2018, and service lines were educated. A PAAF initiative began in June 2019, whereby the antimicrobial stewardship team performed daily reviews of patients receiving antimicrobials for UTIs. Data was collected on their management, and providers were contacted in real time with recommendations based on the institutional guideline. Patients reviewed June–October 2019 were included in the postimplementation analysis. Patients were excluded if they were pregnant, underwent a urological procedure with risk of mucosal bleeding, or were an outside hospital transfer already on UTI therapy. The primary outcome of this study was to evaluate guideline adherence before and after the implementation of PAAF for the management of UTIs. Results: In total, 198 patients in the preintervention group and 246 in the PAAF group were included. The emergency department was the primary ordering service of urinalyses (60.1% vs 66.1%; P = .2287) in both periods and altered mental status as the main indication for testing (35.2% vs 31.3%; P = .5465). Treatment of asymptomatic bacteriuria and pyuria decreased significantly between the 2 periods: 74.8% versus 36.2% (P = .0001). Appropriate ordering of urinalyses (33.8% vs 68.3%; P = .0001) and urine cultures (29.3% vs 61.0%; P = .0001) also improved in the PAAF group. Recommendations made during PAAF included therapy discontinuation (66.7%), antimicrobial therapy change (15.5%), or duration modification (15.5%), and 59.5% of first interventions were accepted. Overall guideline compliance significantly improved from 13.1% in the preintervention period to 26.1% in the PAAF period (P = .0011). Conclusions: A UTI disease state intervention was associated with significant reductions in the treatment of asymptomatic presentations as well as an improvement in overall guideline adherence. We believe that this approach represents a powerful stewardship strategy for decreasing unnecessary antimicrobial usage.Funding: NoneDisclosures: None

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