The Frequency of Antibiotic Treatment of Positive Urine Cultures in Hospitalized Patients that are not UTIs: A Three Hospital Survey
Methods: We reviewed 299 urine cultures from unique individuals at 3 medical centers in Los Angeles (a community hospital, a county hospital, and a private tertiary care medical center) using a standardized chart abstraction form. For each positive culture, we assessed for symptomatic urinary tract infections (SUTI) using both IDSA and NHSN criteria, and evaluated antibiotic treatment and indications.
RESULTS:Of the 299 positive cultures, criteria for SUTI was met infrequently: 29% using IDSA criteria, and 29% using NHSN surveillance criteria. Concordance between IDSA and NHSN criteria was only 66%. Among the 163 patients not using antibiotics for another reason whose urine culture did not meet clinical SUTI IDSA criteria, 38% (n=62) received antibiotics directed at urine studies within 1 day after urine culture collection. Among 171 patients not meeting SUTI criteria by NHSN criteria and not receiving antibiotics for other reasons, 42% (n=71) received antibiotics directed at urine studies. On day 4 after culture, 50% (59/119) of non-SUTI by IDSA criteria and 43% (53/122) by NHSN criteria were receiving antibiotic treatment. Factors associated with antibiotic receipt for a non-SUTI by IDSA criteria 1 day and 4 days after culture were the same: hospital identity, presence of leukocyte esterase, positive nitrite, and urine leukocyte count.
Conclusion: In our 3 center survey, antibiotic treatment of positive urine cultures that were not SUTI was prevalent both empirically and after culture results were finalized, especially among patients with leukocytes in the urine. Our data suggest that inappropriate antibiotic treatment of positive urine cultures that do not represent UTIs is highly prevalent and a potential target for antimicrobial stewardship programs aiming to reduce inappropriate inpatient antibiotic use.
S. J. Eells, None
S. Choi, None
M. Riva, None
M. Go-Wheeler, None
T. Hossain, None
J. Grein, None