title: Using the urine dipstick to screen out unnecessary urine cultures: implementation at one facility.
abstract: This study examined the utility of performing urine cultures on biochemically negative urine specimens and details the implementation of a policy to cancel these cultures. Four reactions of the Multistix SG (Bayer, Elkhart IN) urine dipstick (protein, occult blood, leukocyte esterase, and nitrite) were used as biochemical indicators. A three-month retrospective study examining the results of 843 urinalysis/ urine culture pairs indicated that one-third of these cultures were probably unnecessary (negative dipstick/negative culture). Based on these results, a policy was implemented to screen those urine samples having both a urinalysis and urine culture ordered. Over a six-month period, 6,192 urine specimens were evaluated. Of these, 36% (2,260 cultures) were cancelled. Of the 3,932 samples cultured 22.4% (883) were true positives (positive dipstick/positive culture) while 31.6% (1245) had a positive dipstick but grew organisms considered contaminants. The false positive rate was 40% (positive dipstick/negative culture), and the false negative rate was 6%. Implementation of this policy reduced the number of urines cultured by 36%.
authors.affiliation: Immunology and Microbiology Laboratories, Wilford Hall Medical Center, Lackland AFB TX, USA. patricia.reilly@aviano.af.mil
authors.forename: Patricia
authors.initials: P
authors.lastname: Reilly
authors.forename: Laura
authors.initials: L
authors.lastname: Mills
authors.forename: Daniel
authors.initials: D
authors.lastname: Bessmer
authors.forename: Celia
authors.initials: C
authors.lastname: Jimenez
authors.forename: Patrick
authors.initials: P
authors.lastname: Simpson
authors.forename: Mark
authors.initials: M
authors.lastname: Burton
mesh_terms: D000465:Algorithms; D018929:Cell Culture Techniques / Q000379:methods*; D003581:Cytodiagnosis / Q000379:methods*; D006801:Humans; D012680:Sensitivity and Specificity; D016482:Urinalysis / Q000379:methods*