294. Improving the Culture of Culturing: When Do Resident Physicians Obtain Urine Cultures, and What Do they Do with Them?
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Fakih Urine Cx Survey ID Week 2015.pdf (7.2 MB)
  • Background: The diagnosis and management of catheter associated urinary tract infections (CAUTIs) starts by obtaining a urine culture, often triggered by subjective observations that may not relate to infection.

    Methods: We surveyed medicine and surgery resident physicians (RPs) in 2 large teaching hospitals on what triggers a urine culture in a catheterized patient and when to administer antimicrobials for a positive urine culture result.

    Results: 124 RPs participated in the survey. About half of the RPs (58/124; 46.8%) felt their knowledge about the diagnosis of CAUTI is above average or excellent, and 68.5% received lectures addressing appropriate indications for urine cultures within the last year. RPs showed less than optimal knowledge on what triggers ordering a urine culture in patients with an indwelling catheter with RPs obtaining urine cultures for foul smelling urine (45%), cloudy urine (42%), sediments in urine (26.5%), hematuria (16.6%), chronic urinary catheter on admission (16.1%), and darker looking urine (15%). Residents tended to order more urine cultures the higher the urine analysis white cell counts: for 25 cells (33.3%), for 100 cells (67.5%), and for 500 cells (82.5%). For asymptomatic bacteriuria, 58.3% would change the catheter, 24.2% would treat bacteriuria for a patient going for a non-urologic surgery, and 17.5% will administer antibiotics.

    Conclusion: There are significant opportunities for improvement in training the resident physicians regarding the appropriate reasons for collecting urine cultures, the clinical diagnosis of CAUTI, and management. We suggest programs to evaluate their residents’ knowledge and practice, and implement educational interventions if needed.

    Mohamad G. Fakih, MD, MPH, FIDSA, FSHEA1, Karen Jones, RN, BSN2, Elango Edhayan, MD3, Ana C. Bardossy, MD4, Takiah Williams, BSN, RN5, Katherine Reyes, MD, MPH6, Raymond Hilu, MD7, Marcus Zervos, MD, FIDSA6, Mina El-Kateb, MD8, Rebecca Battjes, BA2, Steven Minnick, MD, MBA9 and Louis Saravolatz, MD, FIDSA10, (1)Infection Prevention and Control, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, (2)Infection Prevention, St John Hospital & Medical Center, Grosse Pointe Woods, MI, (3)Surgery, St John Hospital and Medical Center, Detroit, MI, (4)Infectious Diseases, Henry Ford Health System, Detroit, MI, (5)Infection Prevention and Control, St John Hospital & Medical Center, Grosse Pointe Woods, MI, (6)Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, (7)Internal Medicine, St John Hospital and Medical Center, Grosse Pointe Woods, MI, (8)Internal Medicine, St John Hospital & Medical Center, Detroit, MI, (9)Medical Education, St John Hospital and Medical Center, Grosse Pointe Woods, MI, (10)Internal Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI

    Disclosures:

    M. G. Fakih, None

    K. Jones, None

    E. Edhayan, None

    A. C. Bardossy, None

    T. Williams, None

    K. Reyes, None

    R. Hilu, None

    M. Zervos, None

    M. El-Kateb, None

    R. Battjes, None

    S. Minnick, None

    L. Saravolatz, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.