Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Advisory Board Company, Washington, District of Columbia.
Clin Infect Dis. 2017 Oct 1;65(7):1199-1205. doi: 10.1093/cid/cix424.
Overuse of urine testing is a driver of inappropriate antimicrobial use. Limiting wasteful testing is important for patient safety. We examined the national prevalence and patterns of urine testing during adult inpatient admission in the United States.
We performed a retrospective cohort study using a national dataset of inpatient admissions from 263 hospitals in the United States from 2009 to 2014. We included all adult inpatient admissions, excluding those related to pregnancy, urology procedures, and with lengths of stay >30 days. A facility-level fixed-effects quasi-Poisson regression model was used to examine the incidence of urinalysis and urine culture testing for select diagnoses and patient factors.
The cohort included 4473655 admissions. Charges for urinalysis were present for 2086697 (47%) admissions, with 584438 (13%) including >1 urinalysis. Charges for urine culture were present for 1197242 (27%) admissions, with 246211 (6%) having >1 culture. Urine culture testing varied by principal diagnosis. Heart failure and acute myocardial infarction had 29% and 35% fewer cultures sent on the first day of admission compared to all other admissions (P < .001). Female sex and receipt of antibiotics during the hospital admission consistently predicted increased culture testing, regardless of principal diagnosis or age.
Urine testing was common and frequently repeated during inpatient admission, suggesting large-scale overuse. The variation in testing by diagnosis suggests that clinical presentation modifies test use. The sex bias in urine testing is not clinically supported and must be addressed in interventions aimed at reducing excess urine testing.
尿液检测过度是导致不合理使用抗生素的一个因素。限制不必要的检测对于患者安全至关重要。我们研究了美国成年住院患者尿液检测的全国流行率和模式。
我们使用美国 263 家医院 2009 年至 2014 年的住院患者全国数据集进行了回顾性队列研究。我们纳入了所有成年住院患者，但不包括与妊娠、泌尿科手术和住院时间>30 天相关的患者。采用设施水平固定效应拟泊松回归模型，研究了特定诊断和患者因素与尿液分析和尿液培养检测的发生率。
该队列包括 4473655 例住院患者。2086697 例（47%）住院患者有尿液分析收费记录，其中 584438 例（13%）包含>1 次尿液分析。1197242 例（27%）住院患者有尿液培养收费记录，其中 246211 例（6%）包含>1 次尿液培养。尿液培养检测因主要诊断而异。心力衰竭和急性心肌梗死患者在入院第一天接受的培养数量比所有其他患者分别减少了 29%和 35%（P<0.001）。女性和住院期间使用抗生素与培养检测增加有关，与主要诊断或年龄无关。
尿液检测在住院期间很常见且经常重复，表明存在大规模过度使用。诊断时检测的差异表明临床表现会影响检测的使用。尿液检测的性别偏差没有临床依据，必须在旨在减少过度尿液检测的干预措施中加以解决。
