SHM Converge Scientific Abstract ePoster Gallery-Reflex Urine Testing and Treatment of Asymptomatic Bacteriuria

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This study examined whether “urinalysis with reflex to culture” helps reduce unnecessary antibiotic treatment for asymptomatic bacteriuria (ASB) in hospitalized patients. ASB is common and often mistaken for a urinary tract infection, leading to avoidable antibiotic use.<br /><br />Researchers analyzed data from 39 hospitals in the Michigan Hospital Medicine Safety Consortium between December 2016 and February 2020. They looked at hospital stewardship practices and compared the percentage of patients treated with antibiotics for UTI who actually had ASB, using guideline-based definitions from medical records.<br /><br />Key findings:<br />- Most hospitals (62%, 24/39) had stewardship interventions aimed at reducing unnecessary urine cultures.<br />- Four hospitals added reflex urine culture testing during the study period.<br />- Five hospitals removed reflex testing during the study period.<br /><br />Results showed:<br />- Hospitals that added reflex testing had no meaningful change in ASB treatment, with rates going from 27.9% to 30.1% (p = 0.80).<br />- Hospitals that removed reflex testing had a significant decrease in ASB treatment, from 25.2% to 14.6% (p = 0.001).<br /><br />The authors concluded that adding reflex urine cultures does not appear to improve ASB stewardship and may even worsen overtreatment if clinicians interpret positive culture results as a reason to prescribe antibiotics. They suggest hospitals should reconsider whether reflex urine cultures are beneficial, though they note limitations such as not accounting for other stewardship interventions or non-antibiotic benefits like reduced lab burden.

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Guinn Dunn

Meta Tag

Author List Anurag N. Malani, David Ratz, Elizabeth McLaughlin, Guinn Dunn, Jennifer K. Horowitz, Lama M. Hsaiky, Lindsay A. Petty, Scott A. Flanders, Tejal N. Gandhi, Valerie M. Vaughn

Category Research

Concept Asymptomatic Bacteriuria

Concept Urinary Tract Infection

Concept ASB Treatment

Concept Urinalysis

Concept Reflex Culture

Distinguished Non-Finalist

Presenter Organization University of Utah Department of Internal Medicine

Presenting Author Guinn Dunn

Track Quality Improvement

Keywords

urinalysis

reflex culture

asymptomatic bacteriuria

antibiotic stewardship

urine culture

hospitalized patients

overtreatment

urinary tract infection

Michigan Hospital Medicine Safety Consortium

stewardship interventions

Asymptomatic Bacteriuria

Urinary Tract Infection

ASB Treatment

Urinalysis

Reflex Culture