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Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship.

Publication ,  Journal Article
Advani, SD; Turner, NA; Schmader, KE; Wrenn, RH; Moehring, RW; Polage, CR; Vaughn, VM; Anderson, DJ
Published in: Infect Control Hosp Epidemiol
February 2023

BACKGROUND: Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations. METHODS: In this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL). RESULTS: In 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters. CONCLUSION: When used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.

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Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

February 2023

Volume

44

Issue

2

Start / End Page

206 / 209

Location

United States

Related Subject Headings

  • Urine
  • Urinary Tract Infections
  • Urinalysis
  • Retrospective Studies
  • Reflex
  • Pyuria
  • Humans
  • Female
  • Epidemiology
  • Bacteriuria
 

Citation

APA
Chicago
ICMJE
MLA
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Advani, S. D., Turner, N. A., Schmader, K. E., Wrenn, R. H., Moehring, R. W., Polage, C. R., … Anderson, D. J. (2023). Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship. Infect Control Hosp Epidemiol, 44(2), 206–209. https://doi.org/10.1017/ice.2022.315
Advani, Sonali D., Nicholas A. Turner, Kenneth E. Schmader, Rebekah H. Wrenn, Rebekah W. Moehring, Christopher R. Polage, Valerie M. Vaughn, and Deverick J. Anderson. “Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship.Infect Control Hosp Epidemiol 44, no. 2 (February 2023): 206–9. https://doi.org/10.1017/ice.2022.315.
Advani SD, Turner NA, Schmader KE, Wrenn RH, Moehring RW, Polage CR, et al. Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship. Infect Control Hosp Epidemiol. 2023 Feb;44(2):206–9.
Advani, Sonali D., et al. “Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship.Infect Control Hosp Epidemiol, vol. 44, no. 2, Feb. 2023, pp. 206–09. Pubmed, doi:10.1017/ice.2022.315.
Advani SD, Turner NA, Schmader KE, Wrenn RH, Moehring RW, Polage CR, Vaughn VM, Anderson DJ. Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship. Infect Control Hosp Epidemiol. 2023 Feb;44(2):206–209.
Journal cover image

Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

February 2023

Volume

44

Issue

2

Start / End Page

206 / 209

Location

United States

Related Subject Headings

  • Urine
  • Urinary Tract Infections
  • Urinalysis
  • Retrospective Studies
  • Reflex
  • Pyuria
  • Humans
  • Female
  • Epidemiology
  • Bacteriuria