Reflex Urine Culture Practices in a Regional Community Hospital Network

Background: Reflex urine cultures (RUCs) have the potential to reduce unnecessary urine cultures and antibiotic use. However, urinalysis parameters that best predict true infection are unknown. In this study, we surveyed different RUC practices in laboratories across a regional network of community hospitals. Methods: We conducted a voluntary electronic survey of infection preventionists to describe laboratory practices relating to RUCs across 51 community hospitals in the Duke Infection Control Outreach Network (DICON) between May 15, 2019, and July 3, 2019. Results: We received 51 responses (response rate, 100%). Most hospital laboratories were located in North Carolina (n = 25, 49%) and Georgia (n = 18, 35%); 28 laboratories (55%) incorporated RUCs. Surveyed laboratories accepted urine samples from any source and various collection methods (eg, indwelling catheter specimens, clean catch specimens). Moreover, 24 laboratories (86%) offered RUCs for all patients, whereas 4 laboratories (14%) restricted RUCs to specific populations (ie, outpatient, emergency room or children). We observed wide variability in the urinalysis criteria used for RUCs (Table 1); 26 unique approaches were used among 28 laboratories. Also, 24 laboratories (86%) used multiple criteria and 4 (14%) used 1 criterion. Of those that used multiple criteria, all 24 proceeded to RUC if at least 1 UA criterion was met. Furthermore, 22 laboratories (79%) incorporated the presence of nitrites as a urinalysis criterion; 21 laboratories (75%) incorporated white blood cell count (WBC) as a criterion. The most frequent WBC cutoffs were “≥5” (n = 11, 39%) and “≥10” (n = 7, 25%). In addition, 21 laboratories (75%) incorporated leukocyte esterase as a urinalysis criterion, with criteria including “positive” (n = 15, 54%), “trace” (n = 4, 14%), “moderate” (n = 1, 4%), and “large” (n = 1, 4%). Also, 17 (61%) laboratories incorporated magnitude of bacteriuria as a urinalysis criterion. The cutoff ranged from “few” (n = 8, 29%), “moderate” (n = 7, 25%), to “many” (n = 2, 7%). Another 3 (11%) laboratories incorporated other criteria: presence of blood (n = 2, 7%) and presence of fungal elements (n = 1, 4%). Only 3 (11%) laboratories utilized epithelial cells as an exclusion criterion where urinalysis would not proceed to culture if epithelial cells in urinalysis samples exceeded the designated limit, ranging from “>5” to “>15”. Conclusions: More than half of the hospitals in our community hospital network utilize RUCs, but criteria varied widely. Future epidemiological research should aim to identify ideal urinalysis parameters as well as specific patient populations that safely benefit from RUC strategies. Funding: None Disclosures: None

Duke Scholars

Author Deverick John Anderson Medicine, Infectious Diseases

Author Jessica Seidelman Medicine, Infectious Diseases

Author Sarah Stamps Lewis Medicine, Infectious Diseases

Author Rebekah Moehring Medicine, Infectious Diseases

Author Sonali Advani Medicine, Infectious Diseases