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Urine Culture on Admission Impacts Antibiotic Use and Length of Stay: A Retrospective Cohort Study

  • Molly J. Horstman (a1) (a2) (a3), Andrew M. Spiegelman (a4), Aanand D. Naik (a1) (a2) (a3) and Barbara W. Trautner (a1) (a2) (a5)

Abstract

OBJECTIVE

To examine the impact of urine culture testing on day 1 of admission on inpatient antibiotic use and hospital length of stay (LOS).

DESIGN

We performed a retrospective cohort study using a national dataset from 2009 to 2014.

SETTING

The study used data from 230 hospitals in the United States.

PARTICIPANTS

Admissions for adults 18 years and older were included in this study. Hospitalizations were matched with coarsened exact matching by facility, patient age, gender, Medicare severity-diagnosis related group (MS-DRG), and 3 measures of disease severity.

METHODS

A multilevel Poisson model and a multilevel linear regression model were used to determine the impact of an admission urine culture on inpatient antibiotic use and LOS.

RESULTS

Matching produced a cohort of 88,481 patients (n=41,070 with a culture on day 1, n=47,411 without a culture). A urine culture on admission led to an increase in days of inpatient antibiotic use (incidence rate ratio, 1.26; P<.001) and resulted in an additional 36,607 days of inpatient antibiotic treatment. Urine culture on admission resulted in a 2.1% increase in LOS (P=.004). The predicted difference in bed days of care between admissions with and without a urine culture resulted in 6,071 additional bed days of care. The impact of urine culture testing varied by admitting diagnosis.

CONCLUSIONS

Patients with a urine culture sent on day 1 of hospital admission receive more days of antibiotics and have a longer hospital stay than patients who do not have a urine culture. Targeted interventions may reduce the potential harms associated with low-yield urine cultures on day 1.

Infect Control Hosp Epidemiol 2018;39:547–554

Copyright

Corresponding author

Address correspondence to Molly J. Horstman, MD, Center for Innovations in Quality, Effectiveness, and Safety (152), 2002 Holcombe Boulevard, Houston, Texas 77030 (molly.horstman@bcm.edu) or Barbara Trautner, MD, PhD, Center for Innovations in Quality, Effectiveness, and Safety (152), 2002 Holcombe Boulevard, Houston, Texas 77030 (trautner@bcm.edu).

Footnotes

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PREVIOUS PRESENTATION. The findings in this manuscript were presented as a poster (#81) at the 2017 Society of Hospital Medicine Annual Meeting on May 2, 2017, in Las Vegas, Nevada. The abstract was a finalist in the poster competition.

Footnotes

References

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Urine Culture on Admission Impacts Antibiotic Use and Length of Stay: A Retrospective Cohort Study

  • Molly J. Horstman (a1) (a2) (a3), Andrew M. Spiegelman (a4), Aanand D. Naik (a1) (a2) (a3) and Barbara W. Trautner (a1) (a2) (a5)

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