A 78-year-old woman with lethargy and a positive urine culture

Vaisman, A; Gold, Wayne L.; Leis, Jerome A

doi:10.1503/cmaj.121860

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…Alteration in urine color, odor, or sediment is associated with a positive urine culture, 28 but the literature emphasizes that most people with cloudy or odorous urine are not sick. 29,30 Furthermore, bacteriuria in asymptomatic NH patients is d Among these cases, 13 had an organism reported at <100,000 CFU/cm 3 ; 2 were reported as "polymicrobial"; and 1 reported no bacteria.…”

Section: Discussionmentioning

confidence: 99%

Urine Culture Testing in Community Nursing Homes: Gateway to Antibiotic Overprescribing

Sloane

Kistler

Reed

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To describe current practice around urine testing and identify factors leading to overtreatment of asymptomatic bacteriuria in community nursing homes (NHs) DESIGN Observational study of a stratified random sample of NH patients who had urine cultures ordered in NHs within a 1-month study period SETTING 31 NHs in North Carolina PARTICIPANTS 254 NH residents who had a urine culture ordered within the 1-month study period METHODS We conducted an NH record audit of clinical and laboratory information during the 2 days before and 7 days after a urine culture was ordered. We compared these results with the urine antibiogram from the 31 NHs. RESULTS Empirical treatment was started in 30% of cases. When cultures were reported, previously untreated cases received antibiotics 89% of the time for colony counts of ≥100,000 CFU/mL and in 35% of cases with colony counts of 10,000-99,000 CFU/mL. Due to the high rate of prescribing when culture results returned, 74% of these patients ultimately received a full course of antibiotics. Treated and untreated patients did not significantly differ in temperature, frequency of urinary signs and symptoms, or presence of Loeb criteria for antibiotic initiation. Factors most commonly associated with urine culture ordering were acute mental status changes (32%); change in the urine color, odor, or sediment (17%); and dysuria (15%). CONCLUSIONS Urine cultures play a significant role in antibiotic overprescribing. Antibiotic stewardship efforts in NHs should include reduction in culture ordering for factors not associated with infection-related morbidity as well as more scrutiny of patient condition when results become available. Infect Control Hosp Epidemiol 2017;38:524-531.

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Section: Discussionmentioning

confidence: 99%

Urine Culture Testing in Community Nursing Homes: Gateway to Antibiotic Overprescribing

Sloane

Kistler

Reed

et al. 2017

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

show abstract

“…5 Therefore, these abnormalities should not constitute a urinary tract infection diagnosis in a patient who can reliably report the presence or absence of urinary symptoms, as in the case presented. 2 Our case highlights the importance of appreciating clinical context when both ordering urine cultures and interpreting results. In the absence of urinary symptoms and the presence of an alternate diagnosis, the positive culture in the patient likely represented asymptomatic bacteriuria, rather than a urinary tract infection.…”

Section: The Authors Respondmentioning

confidence: 82%

“…We thank Ackerman and colleagues 1 for their discussion related to our article 2 and for taking the time to poll their colleagues on how they would have managed the patient in the clinical scenario. Interpretation of positive urine culture results has long been the subject of passionate debate in the literature.…”

Section: The Authors Respondmentioning

confidence: 99%