1158. Discontinuation of Urine Cultures by Infection Preventionists in Hospitalized Patients with Indwelling Urinary Catheters: Is It Safe?

Abstract

BackgroundA majority of healthcare-associated urinary tract infections (UTIs) are caused by the use of urinary catheters (CAUTI). Finding of bacteriuria is common in catheterized patients and often leads to unnecessary antibiotic treatment, increased length of stay and additional healthcare costs. We implemented an innovative intervention to improve urine culture (UCx) orders and prevent overdiagnosis of CAUTIs.MethodsOrders for UCx in adult patients with short-term urinary catheters at NorthShore University HealthSystem, IL were reviewed daily for appropriateness based on the Infectious Diseases Society of America Guidelines. Appropriate urine testing was defined as: (1) presence of fever ( >38°C) within past 48 hours, (2) new urinary complaints: flank or suprapubic pain/tenderness or dysuria, frequency, urgency or incontinence within 48 hours after catheter removal, and (3) no other reasonable explanation for fever. If UCx was deemed inappropriate, ordering provider was contacted to cancel the order. Chart review was performed at least 30-days post-discharge to determine whether patients developed recurrent UTI, sepsis, were readmitted or expired.ResultsBetween 1 January to 31 March 2019, 65 UCx were submitted. Sixty-four patients (98%) did not meet criteria for testing. Most common reasons for not meeting criteria were absence of fever (60%) and no localizing UTI signs or symptoms (57%). 35 (54%) UCx were canceled after discussion with ordering providers. 21/35 patients (60%) were treated with antibiotics. All 35 patients were discharged, with a majority going to a skilled nursing facility (34%) or home (31%). 4/35 (11%) had a subsequent positive UCx. Two patients developed symptomatic UTI (sUTI) during the index admission. Two patients developed sUTI within 30-days post-discharge; one patient was transitioned to hospice after completion of therapy. All 4 patients were treated for sUTI.ConclusionWe were able to safely discontinue UCx in 89% of patients. A majority of patients were already started on empiric treatment and development of subsequent sUTI was infrequent (11% of patients). Our findings suggest that discontinuation of inappropriately ordered UCx is safe with low risk for sepsis or mortality.Disclosures All authors: No reported disclosures.