Decreasing urine culture rates in hospitalized internal medicine patients.
Physician education
Rates
Reflex urine culture cancellation
Urine analysis
Journal
American journal of infection control
ISSN: 1527-3296
Titre abrégé: Am J Infect Control
Pays: United States
ID NLM: 8004854
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
03
02
2020
revised:
19
04
2020
accepted:
20
04
2020
pubmed:
26
4
2020
medline:
25
6
2021
entrez:
26
4
2020
Statut:
ppublish
Résumé
There are no previous studies on decreasing urine cultures in hospitalized internal medicine patients by a combination of physician education and reflex cancellation of urine cultures in those with a negative dipstick urinalysis. We compared urine culture rates in all hospitalized internal medicine patients 18 years or older before intervening (2016), during medical education efforts (2017), and after reflex cancellation of urine cultures in patients with a negative dipstick (negative leukocyte esterase and nitrites) (2018, 2019). Compared to the preintervention period (2016), urine cultures decreased from a baseline of 32.7% (95% confidence intervals [95%CI]-31.7-33.6) to 26.6% (95%CI-25.8%-27.4%) after medical education efforts, and to 18.2% (95%CI-17.4%-19.0%) and to 15.2 (95%CI-14.5%-15.9%) during the 2 years after reflex cancellation of the urine cultures. There were no physician complaints and there were no urine cultures orders after reflex cancellation. We conclude that physician education and cancellation of urine cultures in those with negative dipsticks resulted in a persistent decrease in urine cultures of around 50%. Extrapolation to other settings requires caution since the results are dependent on patient selection, physician behavior, and methods of urine testing.
Sections du résumé
BACKGROUND
There are no previous studies on decreasing urine cultures in hospitalized internal medicine patients by a combination of physician education and reflex cancellation of urine cultures in those with a negative dipstick urinalysis.
METHODS
We compared urine culture rates in all hospitalized internal medicine patients 18 years or older before intervening (2016), during medical education efforts (2017), and after reflex cancellation of urine cultures in patients with a negative dipstick (negative leukocyte esterase and nitrites) (2018, 2019).
RESULTS
Compared to the preintervention period (2016), urine cultures decreased from a baseline of 32.7% (95% confidence intervals [95%CI]-31.7-33.6) to 26.6% (95%CI-25.8%-27.4%) after medical education efforts, and to 18.2% (95%CI-17.4%-19.0%) and to 15.2 (95%CI-14.5%-15.9%) during the 2 years after reflex cancellation of the urine cultures. There were no physician complaints and there were no urine cultures orders after reflex cancellation.
CONCLUSIONS
We conclude that physician education and cancellation of urine cultures in those with negative dipsticks resulted in a persistent decrease in urine cultures of around 50%. Extrapolation to other settings requires caution since the results are dependent on patient selection, physician behavior, and methods of urine testing.
Identifiants
pubmed: 32334001
pii: S0196-6553(20)30262-5
doi: 10.1016/j.ajic.2020.04.015
pii:
doi:
Substances chimiques
Nitrites
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1361-1364Informations de copyright
Copyright © 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.