Unnecessary tests for half reduced UTIs

Testing for urinary tract infections (UTIs) is often done regularly in hospitals, even when patients do not have symptoms. Such tests "just to be sure" can yield results that lead physicians to prescribe antibiotics when little or no evidence justifies such treatment.

New research now indicates that simply changing the electronic system used by doctors to order urine tests can halve the number of ordered bacterial culture tests without compromising the ability to identify individuals requiring treatment for urinary tract infections. This change encourages physicians to first look for signs of urinary tract infection before testing a patient's urine for bacteria.

The study, conducted by a team from the University of Washington's Faculty of Medicine in St. Louis, is published on February 21 Infection control and hospital epidemiology.

"Excessive testing for urinary tract infections increases health care costs and leads to unnecessary use of antibiotics, resulting in increased resistance to antibiotics," said David K. Warren, author and infectious disease specialist , professor of medicine. "Ordering tests when the patient needs them is a good thing, but ordering tests when it is not indicated wastes resources and can subject them to unnecessary treatment." We were able to significantly reduce the number of tests ordered without compromising quality of care, and substantial savings. "

Bacteria present in the bladder can cause urinary infections, characterized by burning or pain when urinating, frequent urges to urinate, and fever. Urinary tract infections are treated with antibiotics. However, some people – often elderly people or people with diabetes – have harmless bacterial communities in their bladders that do not need to be treated with antibiotics.

Before asking for a urine test to look for bacteria in the urine, infectious disease specialists recommend that doctors first look for signs of bladder infection with the help of A urine test. This test can detect inflammatory cells in the urine, signs of a problematic urinary tract infection that may require treatment with antibiotics. The discovery of bacteria growing in the urine without knowing if the patient has signs or symptoms of infection leaves doctors uncertain about the possible benefit of antibiotic treatment.

"Doctors are stuck with a result that they do not know how to interpret and often prescribe antibiotics, as this seems to be the safest route," said Warren, medical director of infection prevention at the University of Toronto. Barnes-Jewish Hospital.

Warren, lead author Satish Munigala, MD, data badyst in the field of infection control, and his colleagues made two changes to encourage more informative urine testing among their colleagues at Barnes-Jewish Hospital. First, they e-mailed all clinicians, explaining why they ordered a urine test strip test before requesting a bacterial culture test. . Then they changed the electronic control system. They defaulted to a urine strip test followed by a bacterial culture test, rather than a culture-only test, which was previously the first option. Clinicians who wanted to order a culture test alone could still do it, but they had to open an extra screen on their computer.

The researchers compared all the urine culture tests ordered at the Barnes-Jewish hospital during the 15 months preceding the intervention, organized in April 2016, to the following 15 months. Before the intervention, doctors ordered 15,746 urine cultures, or 38 orders per 1,000 patient-days. After that, they ordered 45% less: 8,823 in total, or 21 orders per 1,000 patient days.

In particular, the number of urine cultures in people with catheters (who are at high risk of urinary tract infection) dropped from 7.8 to 1.9 per 1,000 patient-days, while the number of IUs badociated with the catheters has not changed. During each period, 125 urinary tract infections badociated with the catheter were diagnosed.

"Everyone still fears that by ordering fewer urine cultures, we might miss some urinary tract infections, but we have shown that this was not the case," Warren said.

Since it costs around $ 15 to perform a urine culture, the intervention has saved about $ 104,000 in lab costs over a 15-month period. The researchers were unable to obtain pharmacy records to determine whether more careful testing was reducing antibiotic prescriptions, but previous studies have shown that minimizing unjustified testing actually helps to reduce the need for antibiotics. reduce the excessive use of antibiotics.

Provided by
University of Washington School of Medicine