Back to Search
Start Over
Reflex urine culture testing in an ambulatory urology clinic: Implications for antibiotic stewardship in urology
- Source :
- International Journal of Urology. 26:69-74
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
Abstract
- To evaluate the performance characteristics of urinalysis and urine microscopy parameters for predicting urine culture results and to implement a reflex urine culture program.We reviewed the charts of all patients presenting to our clinic January-March 2013 and June-August 2014, excluding those who were catheter-dependent or with urinary diversions. We assessed the association of urinalysis and urine microscopy parameters on urine culture outcomes defining a positive urinalysis as nitrite-positive and/or the presence of ≥5 white blood cells per high-powered field with bacteria and a positive urine culture as ≥10 000 colony-forming units/mL excluding diphtheroids. We carried out logistic regression to assess for predictors of positive urine culture to inform implementation of a reflex urine culture program.A total of 2764 patients were evaluated. Logistic regression using urinalysis variables identified positive nitrites (odds ratio 18.6, P 0.001) and large leukocyte esterase (odds ratio 41.8, P 0.001) as the strongest predictors of positive urine culture. Logistic regression using urine microscopy variables identified50 white blood cells per high-powered field (odds ratio 13.6, P 0.001) and moderate/many bacteria (odds ratio 16.8, P 0.001) as the strongest predictors of positive urine culture. We used our positive urinalysis definition to implement the reflex urine culture program and noted a 60% reduction in urine culture rates over the first 3 months of implementation.A urine positive for nitrites and/or ≥50 white blood cells per high powered field with bacteria seems to have a strong association with a positive urine culture and the best negative predictive value. A reflex urine culture program is an effective strategy to decrease the rates of unnecessary urine culture and their associated costs.
- Subjects :
- Male
Microbiological Techniques
medicine.medical_specialty
Urinalysis
Urology
Urinary system
030232 urology & nephrology
Medical Overuse
Urine
Logistic regression
Antimicrobial Stewardship
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Internal medicine
medicine
Humans
Aged
medicine.diagnostic_test
business.industry
Odds ratio
Middle Aged
Anti-Bacterial Agents
Logistic Models
030220 oncology & carcinogenesis
Urinary Tract Infections
Ambulatory
Urology clinic
Reflex
Female
business
Subjects
Details
- ISSN :
- 09198172
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- International Journal of Urology
- Accession number :
- edsair.doi.dedup.....3478809ebce7ee534c751b94a7d64584