title: Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center.
abstract: OBJECTIVE To assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected. DESIGN Quasi-experimental study SETTING A 700-bed academic medical center PATIENTS Patients admitted to any adult ICU METHODS Aggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January-December 2012) and after the intervention (January-December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared. RESULTS Statistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed. CONCLUSION A change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams. Infect.
authors.affiliation: 1Department of Pharmacy,University of Maryland Medical Center,Baltimore,Maryland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sarg
authors.affiliation: 2University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Greer E
authors.initials: GE
authors.lastname: Waldrop
authors.affiliation: 3Department of Medicine,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Mona A
authors.initials: MA
authors.lastname: Beier
authors.affiliation: 1Department of Pharmacy,University of Maryland Medical Center,Baltimore,Maryland.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Heil
authors.affiliation: 6Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Thom
authors.affiliation: 4Department of Infection Prevention,University of Maryland Medical Center,Baltimore,Maryland.
authors.forename: Michael Anne
authors.initials: MA
authors.lastname: Preas
authors.affiliation: 5Department of Pathology,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: J Kristie
authors.initials: JK
authors.lastname: Johnson
authors.affiliation: 6Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.affiliation: 6Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Leekha
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001437:Bacteriuria / Q000175:diagnosis*; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D015999:Multivariate Analysis; D011776:Pyuria / Q000175:diagnosis*; D012189:Retrospective Studies; D014556:Urine / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents