Advani Sonali D, Gao Catherine A, Datta Rupak, Sann Lawrence, Smith Cindy, Leapman Michael S, Hittelman Adam B, Sabetta James, Dembry Louise-Marie, Martinello Richard A, Juthani-Mehta Manisha
Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Department of Infection Prevention, Yale New Haven Health, New Haven, Connecticut.
Open Forum Infect Dis. 2019 Aug 1;6(8). doi: 10.1093/ofid/ofz305.
A positive urine culture often drives initiation of antimicrobials even in the absence of symptoms. Our objectives were to evaluate the knowledge and practice patterns related to ordering urine cultures in patients with indwelling urinary catheters.
We performed chart reviews of catheter-associated urinary tract infections (CAUTIs) at our academic health care system between October 1, 2015, and September 30, 2017, to assess practice patterns related to the assessment of potential CAUTIs. Following this, we surveyed physicians and nurses about indications for ordering urine cultures in catheterized patients between January 11, 2018, and April 17, 2018. The accuracy of these indications was assessed based on Infectious Diseases Society of America CAUTI and asymptomatic bacteriuria guidelines.
On chart review, we identified 184 CAUTIs in 2 years. In 159 episodes (86%), urine cultures were ordered inappropriately. In 114 episodes (62%), CAUTI criteria were met by "pan-culturing" rather than symptom-directed testing. Twenty cases (11%) experienced partial or delayed management of other infections, drug adverse events, and Clostridioides difficile infections (CDIs). On our survey, we received 405 responses, for a response rate of 45.3%. Mean scores varied by occupation and level of training. Nurses were more likely than physicians to consider change in appearance (61% vs 23%; P < .05) and odor (74% vs 42%; P < .05) of urine as indications to order urine cultures.
Our data reveal specific knowledge gaps among physicians and nurses related to ordering urine cultures in catheterized patients. The practice of pan-culturing and inappropriate urine culture orders may contribute to overdiagnosis of surveillance CAUTIs, delay in diagnosis of alternative infections, and excess CDIs.
即使在没有症状的情况下，尿培养结果呈阳性也常常促使抗菌药物的使用。我们的目的是评估与留置导尿管患者尿培养检查相关的知识和实践模式。
我们对2015年10月1日至2017年9月30日期间在我们学术医疗系统中发生的导管相关尿路感染（CAUTI）进行了病历审查，以评估与潜在CAUTI评估相关的实践模式。在此之后，我们于2018年1月11日至2018年4月17日对医生和护士进行了关于导尿管插入患者尿培养检查指征的调查。这些指征的准确性根据美国传染病学会CAUTI和无症状菌尿指南进行评估。
通过病历审查，我们在2年内识别出184例CAUTI。在159例（86%）病例中，尿培养检查的开具不恰当。在114例（62%）病例中，通过“全面培养”而非症状导向检测符合CAUTI标准。20例（11%）患者经历了其他感染、药物不良事件和艰难梭菌感染（CDI）的部分或延迟管理。在我们的调查中，我们收到了405份回复，回复率为45.3%。平均得分因职业和培训水平而异。护士比医生更有可能将尿液外观变化（61%对23%；P < 0.05）和气味（74%对42%；P < 0.05）视为开具尿培养检查的指征。
我们的数据揭示了医生和护士在导尿管插入患者尿培养检查开具方面存在特定的知识差距。全面培养和不恰当的尿培养检查开具的做法可能导致监测性CAUTI的过度诊断、替代感染诊断的延迟以及CDI的增加。
