Background: Many cases of catheter-associated urinary tract infection are actually asymptomatic bacteriuria (ASB) that does not require antibiotic treatment. A positive urine culture often drives initiation of antibiotics in ASB. There is a growing need to focus on the culture of culturing. The aim of this project was to evaluate our current practice of obtaining urine cultures in catheterized patients and find opportunities for education.
Methods: This study was conducted at 3 hospitals with 1541, 383, and 206 beds in the Yale New Haven Health System in CT between 01/10/18 and 03/12/18. Electronic and paper surveys were distributed to medical and nursing staff. The survey included questions related to indications for ordering urine cultures in catheterized patients. Appropriateness of culturing was assessed based on Infectious Diseases Society of America guideline recommendations. A 12-point score was calculated with 1 point for each incorrect answer. The differences between the mean scores were analyzed by analysis of variance and t-tests. Data were analyzed using STATA Version 15.
Results: We received 618 complete responses from 330 (54%) nurses and 256 (41.4%) physicians. Mean scores for Hospitals 1, 2 and 3 were not significantly different (4.79, 5.61, 4.87; Figure 1). Physicians scored better than nurses (4.2 vs 5.4, p<0.01), senior trainees (PGY2 and above) scored better than interns, who scored better than medical students (3.9 vs 4.8 vs 6.3, p<0.01). Those working in non-critical care units scored worse than average (5.4 vs 4.9, p<0.01). Peri-urologic surgery, despite being an acceptable indication, was one of the least-selected answers (18%). Nurses were more likely to order urine culture for appearance (61% vs 20% p<0.01) and odor (73% vs 37% p<0.01), when compared to physicians (Figure 2).
Conclusion: Our data show that current urine culture ordering practice in a large teaching healthcare system is not evidence-based. This survey reveals knowledge gaps and the need to address practice competencies, suggesting the need for periodic audits and education in diagnostic stewardship. Future studies should focus on impact and sustainability of educational interventions in these groups.
C. Smith, None
L. Dembry, None
R. Martinello, None
M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor , Consulting fee .
S. Advani, None