Leveraging Data to Explore the Consequences of Urine Testing and Antibiotic Use During the Spinal Cord Injury Annual Evaluation

Objective: The Veterans Health Administration (VHA), the largest single provider of spinal cord injury and disorder (SCI/D) care in the nation, currently mandates that every patient receives a screening urinalysis and urine culture during the annual evaluation. This testing has shown in a small subset of patients to overidentify asymptomatic bacteriuria that is then inappropriately treated with antibiotics. The objective of the current analysis was to assess the impact of the annual evaluation on urine testing and antibiotic treatment and unnecessary prescribing in a national sample of Veterans with SCI/D. Design/Method: A retrospective cohort study using national VHA electronic health record data of Veterans with SCI/D seen October 1, 2017-September 30, 2018 (fiscal year (FY) 2018) for their annual evaluation.Results: There were 9447 Veterans with SCI/D who received an AE in FY2018; 5088 (54%) had a urine culture obtained. 2910 cultures (57%) were positive; E. coli was the most common organism obtained (12.9% of total urine cultures). Of the patients with positive urine cultures, 386 were prescribed antibiotics within the 7 days after that encounter (13%); of the patients with negative cultures (n=2178), 121 (6%) were prescribed antibiotics; thus, a positive urine culture was a significant driver of antibiotic use (p Conclusion: The urine cultures ordered at the annual exam are often followed by antibiotics; this practice may be an important target for antibiotic stewardship programs in SCI.