A positive urine culture often drives initiation of antimicrobials even in the absence of symptoms. Our objectives were to evaluate the knowledge and practice patterns related to ordering urine cultures in patients with indwelling urinary catheters.
We performed chart reviews of catheter-associated urinary tract infections (CAUTIs) at our academic health care system between October 1, 2015, and September 30, 2017, to assess practice patterns related to the assessment of potential CAUTIs. Following this, we surveyed physicians and nurses about indications for ordering urine cultures in catheterized patients between January 11, 2018, and April 17, 2018. The accuracy of these indications was assessed based on Infectious Diseases Society of America CAUTI and asymptomatic bacteriuria guidelines.
On chart review, we identified 184 CAUTIs in 2 years. In 159 episodes (86%), urine cultures were ordered inappropriately. In 114 episodes (62%), CAUTI criteria were met by "pan-culturing" rather than symptom-directed testing. Twenty cases (11%) experienced partial or delayed management of other infections, drug adverse events, and Clostridioides difficile infections (CDIs). On our survey, we received 405 responses, for a response rate of 45.3%. Mean scores varied by occupation and level of training. Nurses were more likely than physicians to consider change in appearance (61% vs 23%; P < .05) and odor (74% vs 42%; P < .05) of urine as indications to order urine cultures.
Our data reveal specific knowledge gaps among physicians and nurses related to ordering urine cultures in catheterized patients. The practice of pan-culturing and inappropriate urine culture orders may contribute to overdiagnosis of surveillance CAUTIs, delay in diagnosis of alternative infections, and excess CDIs.
Open forum infectious diseases. 2019 Aug 01 [Epub]
Sonali D Advani, Catherine A Gao, Rupak Datta, Lawrence Sann, Cindy Smith, Michael S Leapman, Adam B Hittelman, James Sabetta, Louise-Marie Dembry, Richard A Martinello, Manisha Juthani-Mehta
Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut., Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut., Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Department of Infection Prevention, Yale New Haven Health, New Haven, Connecticut., Department of Urology, Yale School of Medicine, New Haven, Connecticut., Greenwich Hospital, Greenwich, Connecticut.