title: Urinalysis requests on the elderly residing in the Auckland community: tick box requesting?
abstract: OBJECTIVE
  Urinalysis for microscopy and culture is one of the most frequently requested tests for microbiology laboratories, particularly from elderly patients. This study sought to describe the clinical appropriateness of urinalysis from community-dwelling elderly patients and subsequent antibiotic prescription.
  
  
  METHODS
  Demographic, laboratory, and antibiotic prescription data were collected on all samples submitted from patients ≥ 70 years during August 2014 to Labtests Auckland. In addition, clinical data were collected by questionnaire from a subgroup of 200 patients.
  
  
  RESULTS
  During August 2014, approximately 7% of the Auckland population aged ≥ 70 years had urinalysis submitted. Urine dipstick was not routinely performed before specimen submission, particularly from patients living at home rather than a long-term care facility, and nearly 50% of samples were not cultured due to absence of pyuria. Escherichia coli was isolated from 23% of female and 7% of male specimens. E. coli isolates from our cohort were less susceptible to all antibiotics tested against compared with all E. coli isolated from all urines in 2014. Clinical indications were absent in 40% of the subgroup of patients. Antibiotic prescription within 7 days of urinalysis was common (36%).
  
  
  CONCLUSIONS
  This study highlights the frequency of urinalysis testing among the elderly residing in the community. Clinical indications are often absent, and treatment of asymptomatic bacteriuria is likely to be contributing to excessive antibiotic prescription in this group of patients.
authors.affiliation: Labtests, 37-41 Carbine Road, Mt Wellington, Auckland 1060. Arlo.upton@labtests.co.nz.
authors.forename: Arlo
authors.initials: A
authors.lastname: Upton
authors.forename: M
authors.initials: M
authors.lastname: McEwan
authors.forename: Deborah
authors.initials: D
authors.lastname: Williamson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000652:urine; D005260:Female; D019538:Health Care Surveys; D006707:Homes for the Aged; D006801:Humans; D057187:Independent Living; D008134:Long-Term Care; D008297:Male; D008485:Medical Audit; D009520:New Zealand; D009735:Nursing Homes; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D016482:Urinalysis / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents