Healthcare Epidemiology Department, Stony Brook University Hospital, Stony Brook, NY.
Department of Pathology, Stony Brook University Hospital, Stony Brook, NY.
Am J Infect Control. 2017 Oct 1;45(10):1143-1153. doi: 10.1016/j.ajic.2017.03.006. Epub 2017 May 2.
Published literature indicates that the unjustified ordering or improper collection of urine for urinalysis or culture from either catheterized patients or those without indwelling devices, or misinterpretation of positive results, often leads to adverse health care events, including increased financial burdens, overreporting of mandated catheter-associated urinary tract infection events, overtreatment of patients with antimicrobial agents, selection of multidrug-resistant organisms, and Clostridium difficile infection. Moreover, national guidelines that provide evidence-based direction on core processes that form the basis for subsequent clinical therapy decisions or surveillance interpretations; that is, the appropriate ordering and collection of urine for laboratory testing and the treatment of patients with symptomatic urinary tract infection, are not widely known or lack adherence. This article provides published evidence on the influence of inappropriate ordering of urine specimens and subsequent treatment of asymptomatic bacteriuria and associated adverse effects; reviews research on bacterial contamination and preservation; and delineates best practices in the collection, handling, and testing of urine specimens for culture or for biochemical analysis in both catheterized and noncatheterized patients. The goal is to provide infection preventionists (IPs) with a cohesive evidence-based framework that will assist them in facilitating the implementation of a urine culture management program that reduces patient harms, enhances the accuracy of catheter-associated urinary tract infection surveillance, improves antibiotic stewardship, and reduces costs.
已发表的文献表明，对导尿或未留置导管的患者进行尿液分析或培养时，如果不合理地下医嘱或不正确地采集尿液，或对阳性结果进行错误解读，通常会导致不良的医疗保健事件，包括增加经济负担、过度报告强制性导管相关尿路感染事件、过度使用抗菌药物治疗患者、选择多药耐药菌和艰难梭菌感染。此外，国家指南提供了循证指导，涉及构成后续临床治疗决策或监测解释基础的核心流程；即，适当地下医嘱采集尿液进行实验室检测，并对有症状的尿路感染患者进行治疗，但这些指南并不广为人知或缺乏遵循。本文提供了关于不适当的尿液标本采集和随后治疗无症状菌尿及其相关不良影响的已发表证据；回顾了细菌污染和保存方面的研究；并描述了在留置和非留置导管患者中采集、处理和检测尿液标本进行培养或生化分析的最佳实践。其目标是为感染预防人员（IP）提供一个具有凝聚力的循证框架，帮助他们实施尿液培养管理计划，从而减少患者伤害，提高导管相关尿路感染监测的准确性，改善抗生素管理，并降低成本。
