title: Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center.
abstract: OBJECTIVE To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria DESIGN Retrospective cohort study SETTING A 1,250-bed academic tertiary referral center PATIENTS Hospitalized adults METHODS This study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital's medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as "isolated." The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures. RESULTS During the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11-1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89-2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47-2.00; surgical ICU aOR, 1.82; 95% CI, 1.51-2.19), and obtaining the urine culture ≥1 calendar day after admission (1-7 days aOR, 1.91; 95% CI. 1.71-2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37-3.34). CONCLUSIONS Isolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections. Infect Control Hosp Epidemiol 2017;38:455-460.
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Washington University School of Medicine,St Louis,Missouri.
authors.forename: Abigail L
authors.initials: AL
authors.lastname: Carlson
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Washington University School of Medicine,St Louis,Missouri.
authors.forename: Satish
authors.initials: S
authors.lastname: Munigala
authors.affiliation: 2Department of Hospital Epidemiology and Infection Prevention,Barnes-Jewish Hospital,St Louis,Missouri.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Russo
authors.affiliation: 2Department of Hospital Epidemiology and Infection Prevention,Barnes-Jewish Hospital,St Louis,Missouri.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McMullen
authors.affiliation: 2Department of Hospital Epidemiology and Infection Prevention,Barnes-Jewish Hospital,St Louis,Missouri.
authors.forename: Helen
authors.initials: H
authors.lastname: Wood
authors.affiliation: 3Department of Pathology and Immunology,Washington University School of Medicine,St Louis,Missouri. (Present affiliation:Christian Hospital Department of Infection Prevention,St Louis,Missouri [K.M.M.]).
authors.forename: Ronald
authors.initials: R
authors.lastname: Jackups
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Washington University School of Medicine,St Louis,Missouri.
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques / Q000706:statistics & numerical data; D055499:Catheter-Related Infections / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008853:Microscopy / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011776:Pyuria / Q000175:diagnosis*; D012189:Retrospective Studies; D012737:Sex Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D016482:Urinalysis / Q000706:statistics & numerical data; D014546:Urinary Catheterization / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000175:diagnosis*; D014556:Urine / Q000382:microbiology*