Urine Culture on Admission Impacts Antibiotic Use and Length of Stay: A Retrospective Cohort Study

Abstract

OBJECTIVETo examine the impact of urine culture testing on day 1 of admission on inpatient antibiotic use and hospital length of stay (LOS).DESIGNWe performed a retrospective cohort study using a national dataset from 2009 to 2014.SETTINGThe study used data from 230 hospitals in the United States.PARTICIPANTSAdmissions for adults 18 years and older were included in this study. Hospitalizations were matched with coarsened exact matching by facility, patient age, gender, Medicare severity-diagnosis related group (MS-DRG), and 3 measures of disease severity.METHODSA multilevel Poisson model and a multilevel linear regression model were used to determine the impact of an admission urine culture on inpatient antibiotic use and LOS.RESULTSMatching produced a cohort of 88,481 patients (n=41,070 with a culture on day 1, n=47,411 without a culture). A urine culture on admission led to an increase in days of inpatient antibiotic use (incidence rate ratio, 1.26; P<.001) and resulted in an additional 36,607 days of inpatient antibiotic treatment. Urine culture on admission resulted in a 2.1% increase in LOS (P=.004). The predicted difference in bed days of care between admissions with and without a urine culture resulted in 6,071 additional bed days of care. The impact of urine culture testing varied by admitting diagnosis.CONCLUSIONSPatients with a urine culture sent on day 1 of hospital admission receive more days of antibiotics and have a longer hospital stay than patients who do not have a urine culture. Targeted interventions may reduce the potential harms associated with low-yield urine cultures on day 1.Infect Control Hosp Epidemiol 2018;39:547-554.

Risk Factors and Outcomes Associated With Treatment of Asymptomatic Bacteriuria in Hospitalized Patients

“…In addition to our study finding no clinical benefit, antibiotic treatment of ASB was associated with a 37% increase in duration of hospitalization after urine testing, suggesting potential harm and additional cost. Similarly, a recent study found that hospitalized patients with a UC on admission, irrespective of their admitting diagnosis, had longer hospital stays compared with patients with no UC . The association of antibiotic treatment with longer duration of hospitalization was robust in sensitivity analyses attempting to account for differences in patients with testing performed later during hospitalization.…”

Patients at Risk for Aortic Rupture Often Exposed to Fluoroquinolones during Hospitalization

“…The hospitals contributing to this database are generally representative of hospitals across the United States, except that there are fewer small facilities (i.e., Ͻ50 beds) and fewer facilities in the western United States; these differences were Յ5% from the national averages determined by the American Hospital Association. We have used this database for prior studies of antibiotic use (43,46).…”

“…Because of the hierarchical nature of the data, we used multilevel logistic regression to analyze the predictive value of various admission characteristics on FQ use in both the AAD group and the Marfan syndrome group. We have used this approach in prior studies to examine the effects of urine culture at admission on antibiotic selection (46). The levels were facilities and attending physicians, which means we accounted for clustering of observations by facility and attending level.…”

Analysis of an Antibiotic Stewardship Program for Asymptomatic Bacteriuria in the Veterans Affairs Health Care System

“…A urine culture is often the first step in a chain of events leading to unnecessary antibiotic use, longer hospital stays, and other harms. 8 , 9 , 10 , 11 Therefore, investigators including members of our team 12 designed an intervention that focuses on reducing both unnecessary urine cultures (diagnostic stewardship) and unnecessary antibiotic use (antibiotic stewardship). This intervention package, the Kicking CAUTI (catheter-associated urinary tract infection) Campaign, consists of a validated guideline-based algorithm plus individualized audit and feedback.…”

“…A urine culture is often the first step in a chain of events leading to unnecessary antibiotic use, longer hospital stays, and other harms . Therefore, investigators including members of our team designed an intervention that focuses on reducing both unnecessary urine cultures (diagnostic stewardship) and unnecessary antibiotic use (antibiotic stewardship).…”