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Inpatient urine cultures are frequently performed without urinalysis or microscopy: Findings from a large academic medical center
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January 05 2017
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Source: Infect Control Hosp Epidemiol. 38(4):455-460
Details:
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Alternative Title:Infect Control Hosp Epidemiol
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Personal Author:
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Description:Objective:
To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria.
Design:
Retrospective cohort study.
Setting:
A 1250-bed academic tertiary referral center.
Patients:
Hospitalized adults.
Methods:
We included urine cultures drawn on four medical and two surgical wards from 2009–2013 and in the medical and surgical intensive care units (ICUs) from 2012–2013. 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:
14,743 urine cultures were obtained (63.5 cultures/1000 patient-days) during 11,820 patient admissions. 2973 cultures (20.2%) were isolated cultures. 31 (50.8%) of 61 CAUTIs 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 in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.
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Source:
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Pubmed ID:28052781
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Pubmed Central ID:PMC6474665
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