The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients
<b>Objective</b>: To assess the impact of changing the reporting threshold policy of positive urine cultures in hospitalized non-pregnant adults from 10<sup>4</sup> CFU/mL to 10<sup>5</sup> CFU/mL on the unwarranted use of antibiotics and patient safety. <b>...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/7014 |
| _version_ | 1797462957118980096 |
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| author | Ohad Gabay Tal Cherki Gal Tsaban Yoav Bichovsky Lior Nesher |
| author_facet | Ohad Gabay Tal Cherki Gal Tsaban Yoav Bichovsky Lior Nesher |
| author_sort | Ohad Gabay |
| collection | DOAJ |
| description | <b>Objective</b>: To assess the impact of changing the reporting threshold policy of positive urine cultures in hospitalized non-pregnant adults from 10<sup>4</sup> CFU/mL to 10<sup>5</sup> CFU/mL on the unwarranted use of antibiotics and patient safety. <b>Setting</b>: A 1100-bed tertiary-care hospital in southern Israel. <b>Methods</b>: As an intervention, we changed urine culture reporting policy for patients admitted to general medical wards. If culture grew ≥10<sup>5</sup> CFU/mL, it was reported with pathogen and antibiotic susceptibility data, if it grew ≤10<sup>4</sup> CFU/mL, it was reported as “low growth". The withheld information was available upon request. We retrospectively collected data on all patients in a four-month period following the intervention and report using STROBE guidelines. <b>Results</b>: 7808 patients were admitted, in whom 3523 urine cultures were obtained. A total of 496 grew a pathogen, 51 were excluded (<i>candida</i> spp. positive, history of urinary surgery, obtained from catheter). A total of 300 were reported as positive and 145 were reported as low-growth. A higher rate of patients in the low-growth group were not treated with antibiotics 45/145(31%) vs. 56/300(18.7%) in the positive group <i>p</i> = 0.015 and the antibiotic duration of treatment was shorter by day 5 (IQR 0.9) vs. 6 (IQR 0.9) <i>p</i> = 0.015. No between-group difference was observed in recurrent admission rates, pyelonephritis within 30 days, bacteremia or all-cause mortality. <b>Conclusions</b>: Changing the reporting threshold of positive urine culture results from 10<sup>4</sup> CFU/mL to 10<sup>5</sup> CFU/mL in hospitalized patients reduced the number of patients who were unnecessarily treated for asymptomatic bacteriuria without negatively impacting patient safety. We urge microbiological laboratories to consider this change in threshold as part of an antimicrobial stewardship program. |
| first_indexed | 2024-03-09T17:43:54Z |
| format | Article |
| id | doaj.art-ba0b5d9d1f73467ca6e7512cde7fd50a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:43:54Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ba0b5d9d1f73467ca6e7512cde7fd50a2023-11-24T11:21:30ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011123701410.3390/jcm11237014The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized PatientsOhad Gabay0Tal Cherki1Gal Tsaban2Yoav Bichovsky3Lior Nesher4Infectious Disease Institute, Internal Medicine Division, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84101, IsraelInfectious Disease Institute, Internal Medicine Division, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84101, IsraelInfectious Disease Institute, Internal Medicine Division, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84101, IsraelInfectious Disease Institute, Internal Medicine Division, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84101, IsraelInfectious Disease Institute, Internal Medicine Division, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84101, Israel<b>Objective</b>: To assess the impact of changing the reporting threshold policy of positive urine cultures in hospitalized non-pregnant adults from 10<sup>4</sup> CFU/mL to 10<sup>5</sup> CFU/mL on the unwarranted use of antibiotics and patient safety. <b>Setting</b>: A 1100-bed tertiary-care hospital in southern Israel. <b>Methods</b>: As an intervention, we changed urine culture reporting policy for patients admitted to general medical wards. If culture grew ≥10<sup>5</sup> CFU/mL, it was reported with pathogen and antibiotic susceptibility data, if it grew ≤10<sup>4</sup> CFU/mL, it was reported as “low growth". The withheld information was available upon request. We retrospectively collected data on all patients in a four-month period following the intervention and report using STROBE guidelines. <b>Results</b>: 7808 patients were admitted, in whom 3523 urine cultures were obtained. A total of 496 grew a pathogen, 51 were excluded (<i>candida</i> spp. positive, history of urinary surgery, obtained from catheter). A total of 300 were reported as positive and 145 were reported as low-growth. A higher rate of patients in the low-growth group were not treated with antibiotics 45/145(31%) vs. 56/300(18.7%) in the positive group <i>p</i> = 0.015 and the antibiotic duration of treatment was shorter by day 5 (IQR 0.9) vs. 6 (IQR 0.9) <i>p</i> = 0.015. No between-group difference was observed in recurrent admission rates, pyelonephritis within 30 days, bacteremia or all-cause mortality. <b>Conclusions</b>: Changing the reporting threshold of positive urine culture results from 10<sup>4</sup> CFU/mL to 10<sup>5</sup> CFU/mL in hospitalized patients reduced the number of patients who were unnecessarily treated for asymptomatic bacteriuria without negatively impacting patient safety. We urge microbiological laboratories to consider this change in threshold as part of an antimicrobial stewardship program.https://www.mdpi.com/2077-0383/11/23/7014asymptomatic bacteruriaantimicrobial stewardshipurinary tract infectiondiagnosis |
| spellingShingle | Ohad Gabay Tal Cherki Gal Tsaban Yoav Bichovsky Lior Nesher The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients Journal of Clinical Medicine asymptomatic bacteruria antimicrobial stewardship urinary tract infection diagnosis |
| title | The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients |
| title_full | The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients |
| title_fullStr | The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients |
| title_full_unstemmed | The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients |
| title_short | The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients |
| title_sort | safety and impact of raising the urine culture reporting threshold in hospitalized patients |
| topic | asymptomatic bacteruria antimicrobial stewardship urinary tract infection diagnosis |
| url | https://www.mdpi.com/2077-0383/11/23/7014 |
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