1544. Appropriateness of Testing and Treatment for Urinary Tract Infection in a Long Term Acute Care Hospital
Session: Poster Abstract Session: Infections in Non-Acute Healthcare Settings
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: The emergence of hospital acquired infections (HAIs) and antimicrobial resistance has resulted in considerable morbidity, mortality, and increased expenditures. Urinary tract infection (UTI) accounts for 40% of all HAIs. However, recent studies have shown that over half of urine cultures in acute care facilities are ordered inappropriately, leading to unnecessary antibiotic therapy and contributing to the development of antimicrobial resistance. This phenomenon has not been studied in long term acute care hospitals (LTACHs), facilities that admit complex patients with acute care needs. We sought to evaluate the appropriateness of testing and antimicrobial treatment for UTI in an LTACH.

Methods: Medical records were retrospectively reviewed from adult patients who had a urine culture collected from February-July 2012 at Select Specialty Hospital Ann Arbor, a 36-bed LTACH. Only the first urine culture was reviewed for those with multiple urine cultures. Data collected included culture results, urinary catheter presence, signs and symptoms of UTI, reasons for ordering a urine culture, antimicrobial therapy, and reasons for/duration of treatment. Appropriateness criteria for testing and antimicrobial therapy were defined according to Infectious Diseases Society of America (IDSA) and Centers for Disease Control and Prevention (CDC) guidelines.

Results: Urine cultures were reviewed in 77 patients. Of the 77 patients, 62 (81%) had a urinary catheter present at the time of culture or removed within 48 hours, 50 (65%) had presence of wounds and 39 (51%) required mechanical ventilation on admission. The most common reasons for ordering a urine culture were fever (31%), change in character of urine (21%), and leukocytosis (18%). Based on national guidelines, 40 cultures (52%) were ordered inappropriately, with no documented reasons in 18 (23%) patients. Of these 40 patients who did not meet appropriateness criteria, 11 (28%) received antibiotics for UTI, resulting in 96 days of antimicrobial therapy.

Conclusion: At our LTACH, over half of urine cultures were obtained outside of accepted criteria – leading to a significant excess of antimicrobial use. As the number of LTACHs continues to increase, testing guidelines for urine cultures in these facilities is urgently needed.

Brandi Burke, MPH1,2, Bonita Singal, MD, PhD2, Eileen Robinson, MPH, RN/BSN2, Suzanne Winter, MS2 and Anurag Malani, MD2, (1)Michigan State University College of Human Medicine, East Lansing, MI, (2)St. Joseph Mercy Hospital, Ann Arbor, MI


B. Burke, None

B. Singal, None

E. Robinson, None

S. Winter, None

A. Malani, None

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