Tackling the folly of misused and misunderstood urine culture tests

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Tackling the folly of misused and misunderstood urine culture tests

17 August 2022

By Juliet Elvy

Wednesday 17 August 2022, 12:20 AM

Escherichia coli, the most common urinary pathogen, on urine culture plate [Image: Supplied]

Urine samples are the most frequent specimen type received in the clinical microbiology laboratory, and a subject of much discussion. This article aims to point clinicians towards urine diagnostic stewardship

Key points, Urine cultures are very commonly ordered, often without clinical indication. Urine diagnostics are imprecise and cannot distinguish infection from , Pract Green w Pale Yellow

Genitourinary

Investigations

References

Nicolle L, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40(5):643–54.
Horstman M, Spiegelman A, Naik A, Trautner B. National patterns of urine testing during inpatient admission. Clin Infect Dis 2017;65(7):1199–205.
Blakiston M, Zaman S. Nosocomial bacteriuria in elderly inpatients may be leading to considerable antibiotic overuse: An audit of current management practice in a secondary level care hospital in New Zealand. Infect Drug Resist 2014;7:301–08.
Linares LA, Thornton DJ, Strymish J, et al. Electronic memorandum decreases unnecessary antimicrobial use for asymptomatic bacteriuria and culture-negative pyuria. Infect Control Hosp Epidemiol 2011;32(7):644–48.
Lee MJ, Kim M, Kim NH, et al. Why is asymptomatic bacteriuria overtreated?: A tertiary care institutional survey of resident physicians. BMC Infect Dis 2015;15:289.
Trautner BW, Grigoryan L, Petersen NJ, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter–associated asymptomatic bacteriuria. JAMA Intern Med 2015;175:1120–27.
Cai T, Nesi G, Mazzoli S, et al. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infections. Clin Infect Dis 2015;61(11):1655–61.
Leis J, Rebick G, Daneman N, et al. Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: A proof-of concept study. Clin Infect Dis 2014;58(7):980–83.
Morgan DJ, Pineles L, Owczarzak J, et al. Accuracy of practitioner estimates of probability of diagnosis before and after testing. JAMA Intern Med 2021;181(6):747–55.
Advani S, Vaughn VM. Quality improvement interventions and implementation strategies for urine culture stewardship in the acute care setting: Advances and challenges. Curr Infect Dis Rep 2021;23(10):16.
Wilson AD, Kelly MJ, Henderson E, et al. Reducing inappropriate urine testing at Hutt Valley District Health Board using Choosing Wisely principles. N Z Med J 2019;132(1488):11–20.

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