Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units

Abstract

Objective: Urine cultures have poor specificity for catheter-associated urinary tract infections (CAUTIs). We evaluated the effect of a urine-culture stewardship program on urine culture utilization and CAUTI in adult intensive care units (ICUs). Design: A quasi-interventional study was performed from 2015 to 2017. Setting and patients: The study cohort comprised 21,367 patients admitted to the ICU at a teaching hospital. Intervention: The urine culture stewardship program included monthly 1-hour discussions with ICU house staff emphasizing avoidance of “pan-culture” for sepsis workup and obtaining urine culture only if a urinary source of sepsis is suspected. The urine culture utilization rate metric (UCUR; ie, no. urine cultueres/catheter days ×100) was utilized to measure the effect. Monthly UCUR, catheter utilization ratio (CUR), and CAUTI rate were reported on an interactive quality dashboard. To ensure safety, catheterized ICU patients (2015–2016) were evaluated for 30-day readmission for UTI. Time-series data and relationships were analyzed using Spearman correlation coefficients and regression analysis. Results: Urine culture utilization decreased from 3,081 in 2015 to 2,158 in 2016 to 1,218 in 2017. CAUTIs decreased from 78 in 2015 to 60 in 2016 and 28 in 2017. Regression analysis over time showed significant decreases in UCUR (r, 0.917; P < .0001) and CAUTI rate (r, 0.657; P < .0001). The co-correlation between UCUR and CAUTI rate was (r, 0.625; P < .0001) compared to CUR and CAUTI rate (r, 0.523; P = .004). None of these patients was readmitted with a CAUTI. Conclusions: Urine culture stewardship program was effective and safe in reducing UC overutilization and was correlated with a decrease in CAUTIs. Addition of urine-culture stewardship to standard best practices could reduce CAUTI in ICUs.

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

“…Diagnostic stewardship strategies could be effective in the treatment and prevention of NHSN CAUTI. 27,29,30 When interventions are implemented to prevent CAUTI, improved outcomes expected are reduced CAUTI, reduced indwelling urethral catheter use, reduced collection and antibiotic use for positive urine cultures, reduced antibiotic-associated complications, and reduced costs associated with these outcomes.…”

“…Diagnostic stewardship strategies could be effective in the treatment and prevention of NHSN CAUTI. 27,29,30…”

A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria

“…Thus, the ultimate goal is to improve culturing practices. Successful urine culture stewardship strategies include reflex urine cultures, order-set hygiene, suppressing urine culture results, or education . Although these efforts have reduced ASB treatment in single-center studies, data from large collaboratives are lacking.…”

“…Successful urine culture stewardship strategies include reflex urine cultures, order-set hygiene, suppressing urine culture results, or education. 15 , 16 , 17 , 18 , 19 , 20 , 21 Although these efforts have reduced ASB treatment in single-center studies, data from large collaboratives are lacking. In addition, it is unclear whether efforts to reduce ASB treatment should focus on diagnostic or antibiotic stewardship.…”