The data and the reality: urine cultures and emergency medicine physicians

Castañeda, Nicolette Rachel; Doodlesack, Amanda; Fyfe, W. S.; Edlow, Jonathan A.; Grossman, Shamai A.

doi:10.1007/s11739-022-03032-7

Cited by 1 publication

(2 citation statements)

References 16 publications

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Section: Urine Culturesmentioning

confidence: 99%

“…Overuse of urine cultures in the hospital increases inappropriate use of antibiotics [ 8 , 57 , 58 , 59 , 60 ]. In patients with a positive urine culture, emergency department physicians in varied training stages often prescribe antibiotics to patients where clear, specific, and data-driven guidelines suggest treatment is unnecessary and potentially harmful [ 60 ]. A retrospective cohort study in 46 hospitals in the United States showed that 83% of patients with asymptomatic bacteriuria were treated with antibiotics [ 59 ] and had prolonged hospital stays.…”

Section: Urine Culturesmentioning

confidence: 99%

See 1 more Smart Citation

Laboratory Tests, Bacterial Resistance, and Treatment Options in Adult Patients Hospitalized with a Suspected Urinary Tract Infection

Froom,

Shimoni

2024

Diagnostics

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Patients treated for systemic urinary tract infections commonly have nonspecific presentations, and the specificity of the results of the urinalysis and urine cultures is low. In the following narrative review, we will describe the widespread misuse of urine testing, and consider how to limit testing, the disutility of urine cultures, and the use of antibiotics in hospitalized adult patients. Automated dipstick testing is more precise and sensitive than the microscopic urinalysis which will result in false negative test results if ordered to confirm a positive dipstick test result. There is evidence that canceling urine cultures if the dipstick is negative (negative leukocyte esterase, and nitrite) is safe and helps prevent the overuse of urine cultures. Because of the side effects of introducing a urine catheter, for patients who cannot provide a urine sample, empiric antibiotic treatment should be considered as an alternative to culturing the urine if a trial of withholding antibiotic therapy is not an option. Treatment options that will decrease both narrower and wider spectrum antibiotic use include a period of watching and waiting before antibiotic therapy and empiric treatment with antibiotics that have resistance rates > 10%. Further studies are warranted to show the option that maximizes patient comfort and safety.

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