title: Point-Counterpoint: Reflex Cultures Reduce Laboratory Workload and Improve Antimicrobial Stewardship in Patients Suspected of Having Urinary Tract Infections.
abstract: Urinary tract infections (UTIs) are frequent and lead to a large number of clinical encounters. A common management strategy for patients suspected of having a urinary tract infection is to test for pyuria and bacteria by urine analysis (UA) of midstream urine, with initiation of antibiotic therapy and urine culture if one or both tests are positive. Although this practice was first used in an outpatient setting with midstream urine samples, some institutions allow its use in the management of catheterized patients. The ideas behind the reflex urine culture are to limit laboratory workload by not performing culture on negative specimens and to improve antimicrobial stewardship by not giving antimicrobials to patients with negative UA results. The questions are, first, whether reflex urine culture reduces workloads significantly and, second, whether it improves antimicrobial stewardship in the era of increasing numbers of urinary tract infections due to extensively drug-resistant Gram-negative bacilli. Romney Humphries from UCLA supports the idea that reflex urine cultures are of value and describes what reflex parameters are most useful, while Jennifer Dien Bard of Children's Hospital Los Angeles discusses their limitations.
authors.affiliation: Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA rhumphries@mednet.ucla.edu jdienbard@chla.usc.edu.
authors.forename: Romney M
authors.initials: RM
authors.lastname: Humphries
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA Keck School of Medicine, University of Southern California, Los Angeles, California, USA rhumphries@mednet.ucla.edu jdienbard@chla.usc.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dien Bard
mesh_terms: D019468:Disease Management; D006801:Humans; D007753:Laboratories; D015141:Los Angeles; D000069342:Medical Overuse; D008828:Microbiological Techniques / Q000379:methods / Q000592:standards; D011776:Pyuria / Q000652:urine; D016482:Urinalysis / Q000379:methods / Q000592:standards; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*