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Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center

Published online by Cambridge University Press:  05 January 2017

Abigail L. Carlson*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Satish Munigala
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Anthony J. Russo
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, Barnes-Jewish Hospital, St Louis, Missouri
Kathleen M. McMullen
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, Barnes-Jewish Hospital, St Louis, Missouri
Helen Wood
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, Barnes-Jewish Hospital, St Louis, Missouri
Ronald Jackups
Affiliation:
Department 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.])
David K. Warren
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
*
Address correspondence to Abigail L. Carlson, MD, Washington University School of Medicine, 4523 Clayton Ave, Campus Box 8051, St Louis, MO 63110 (alcarlson@wustl.edu).

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

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: Presented in part as Abstract no. 7155 at the Society for Healthcare Epidemiology of America Spring 2015 Conference in Orlando, Florida, on May 16, 2015.

References

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Supplementary material: PDF

Carlson supplementary material

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