230. Urine Cultures in Hospitalized Patients
Session: Poster Abstract Session: Diagnostic Microbiology
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDweek.2013.drekonja.pdf (5.3 MB)
  • Background:

    Treatment of asymptomatic bacteriuria (ASB) is common and leads to unnecessary antimicrobial use. Exploring why providers order UCs may help to limit the unnecessary discovery and treatment of ASB. Accordingly, we evaluated UC ordering and subsequent antimicrobial use at a large Veterans Affairs (VA) hospital.

    Methods:

    All UCs obtained from hospitalized patients at the Minneapolis VA Medical Center (MVAMC) were reviewed prospectively, and details regarding symptoms, exam findings, and laboratory studies were recorded. For each UC, we classified the clinical scenario as being (i) possibly consistent with urinary tract infection (UTI), (ii) uninterpretable, or iii) inconsistent with UTI. In the latter instance, ordering providers were contacted and asked why the UC was obtained.

    Results:

    Over a 3-month period in 2011, 496 UCs were obtained from 351 subjects. The subjects were predominantly (97%) male, had a mean age of 68, and many (33%) had indwelling urinary catheters. Although for 344 (69%) UCs the clinical scenario was possibly consistent with UTI, in only 9% did it involve dysuria or frequency. Notably, 74 (15%) UCs were obtained despite a scenario inconsistent with UTI. Common reasons for obtaining these UCs were: unknown (34%), in preparation for a non-urologic procedure (30%), and abnormal urine appearance (18%). A surprisingly small fraction of positive UCs led to antimicrobial therapy, regardless of whether the clinical scenario was possibly consistent with UTI, uninterpretable, or inconsistent with UTI, (31%, 19%, and 18%, respectively: P = .14).

    Conclusion:

    Although most UCs from MVAMC inpatients are obtained in clinical scenarios possibly consistent with UTI, a substantial amount of testing occurs in patients without UTI manifestations. Regardless of clinical scenario, most positive UCs go untreated, which suggests that the documented possible manifestations of UTI were readily explained by an unrelated process and that UC ordering is over-utilized.

    Dimitri M. Drekonja, MD, MS, Infectious Diseases, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, Christina Gnadt, BA, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN and James R. Johnson, MD, University of Minnesota, Minneapolis, MN

    Disclosures:

    D. M. Drekonja, None

    C. Gnadt, None

    J. R. Johnson, None

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