In this episode, I’ll discuss conditional reflex urine culturing for antibiotic stewardship.
Overtreatment of urinary tract infections is a common problem that antimicrobial stewardship teams face. One of the major reasons for this is the overdiagnosis of UTIs. The overdiagnosis leads to overtreatment because providers worry about the rare but potentially negative scenario of withholding treatment instead of focusing on the excess adverse events that comes with unnecessary antibiotic use.
A group of authors published a pre/post intervention study in the journal Clinical Infectious Diseases looking at a particular laboratory intervention that cuts straight to the overdiagnosis problem.
The authors detail how one hospital implemented conditional reflex urine culture ordering, which means that a urine culture is only done by the lab if the patient has a significant amount of white blood cells detected in their urine. This effectively stops the phenomenon of “asymptomatic bacteriuria” because the entire cohort of asymptomatic patients never gets a culture performed due to this rule.
The hospital that implemented this change experienced a 39.5% reduction in days of therapy for patients with a UTI.
The authors concluded:
Conditional reflex urine culturing had a large decrease on UTI antibiotic DOTs and urine cultures performed. Health-systems or medical centers starting urine culture diagnostic stewardship should implement conditional reflex urine culturing first.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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