Students Research in Progress
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) are commonly encountered in the emergency department (ED). Distinguishing between UTIs and ASB is essential to the appropriate antibiotic therapy initiation. Opportunities to optimize screening and management of UTIs and ASB may exist.
Research Question or Hypothesis: Characterize screening, diagnosis, and treatment practices for UTIs in patients discharged from the ED
Study Design: multicenter, retrospective cohort study
Methods: Discharged ED patients with urine cultures ordered during an ED visit between 12/1/2021 and 5/31/2022 were evaluated using data from electronic health records. A random sample of 200 patients was included. Patients were excluded if they were <18 years or had any non-UTI infectious disease-related diagnosis on ED discharge. The primary outcome was the proportion of patients with unnecessary urine cultures defined as non-pregnant patients with the absence of UTI symptoms and no urologic procedure within 7 days. Secondary objectives included proportion of urine cultures ordered prior to urinalysis (UA) resulting, proportion of patients discharged without antibiotics, proportion of patients discharged without a UTI-related ICD-10 code, and proportion of patients discharged with empiric antibiotics who had an unnecessary urine culture.
Results: A total of 24,848 urine cultures were completed from 12/1/2021 to 5/31/2022. Of these cultures, 651 were screened with 200 patients included. The median age was 56 and 76% were female. Of the 200 urine cultures, 90 (45%) were unnecessary and 97 (48.5%) were ordered prior to the UA resulting. Of the 200 patients included, 95 (48%) were discharged without antibiotics and 111 (55.5%) did not have a UTI-related ICD-10 code upon discharge. Of the 90 patients ordered a urine culture unnecessarily, 39 (43%) were discharged on empiric antibiotic therapy.
Conclusion: Over 40% of patients were ordered unnecessary urine cultures, and nearly half the patients had urine cultures ordered prior to availability of UA results.
Presenting Author
Christina Beran BSPS, PharmD CandidateUniversity of Toledo
Authors
Matthew Campbell PharmD
Cleveland Clinic