Enterococcus Infections: Epidemiology, Mortality and Risk Factors in a Regional Hospital in Greece
International Journal of Infectious Diseases
Hypothesis: Urine culture in unselected individuals with negative urine dipstick is unwarranted. Physicians often order urine cultures inappropriately, resulting in false positive cultures and unnecessary antimicrobial use. Methods: Retrospective review of patients who had positive urine culture despite negative dipstick from Jan-Mar 2006. Data were collected on patient demographics, past medical history, presence of urinary symptoms, and documentation of request and results of urinalysis,
... of urinalysis, urine culture and treatment given Results: 4977 urine specimens were received of which 1570 (31.5%) were negative on dipstick but processed for culture by order of the physician. 113 (7.2%) of these resulted in a positive urine culture. Ninety-seven charts were available for review. The mean age was 28 (median 25, range 1-87). Suspected urinary tract infection was listed as a reason for culture in 45/97 (46.4%) patients. Only 18/68 (26.5%) had urinary symptoms (excluding 29 preschool aged children). The order for urine culture was not recorded in 37/97 (38%) and result was not documented in 64/97(66%) of patients. 29/97 (30%) received antibiotics for a total of 285 DDD (Defined Daily Doses) (average 9.8 DDD/patient). A total of 254 DDD of antibiotics were prescribed for which no clear indication could be established from the medical record. Estimated excess material cost to the microbiology laboratory in absence of sieving strategy for urine culture was estimated at $1030/month. Conclusions: We found poor documentation of reasons for urine culture and results by physicians. In addition, in a majority of cases no clear reason could be found for dispensation of antibiotics other than a positive urine culture. Introduction of positive urine dipstick as a sieving strategy for urine culture in low risk patients would reduce inappropriate antibiotic use and lower laboratory costs.