Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Office of Quality, Emory Healthcare, Atlanta, Georgia.
Infect Control Hosp Epidemiol. 2020 Mar;41(3):369-371. doi: 10.1017/ice.2020.5. Epub 2020 Jan 30.
Accurately diagnosing urinary tract infections (UTIs) in hospitalized patients remains challenging, requiring correlation of frequently nonspecific symptoms and laboratory findings. Urine cultures (UCs) are often ordered indiscriminately, especially in patients with urinary catheters, despite the Infectious Diseases Society of America guidelines recommending against routine screening for asymptomatic bacteriuria (ASB).1,2 Positive UCs can be difficult for providers to ignore, leading to unnecessary antibiotic treatment of ASB.2,3 Using diagnostic stewardship to limit UCs to situations with a positive urinalysis (UA) can reduce inappropriate UCs since the absence of pyuria suggests the absence of infection.4-6 We assessed the impact of the implementation of a UA with reflex to UC algorithm ("reflex intervention") on UC ordering practices, diagnostic efficiency, and UTIs using a quasi-experimental design.
准确诊断住院患者的尿路感染（UTI）仍然具有挑战性，需要结合经常出现的非特异性症状和实验室发现进行判断。尽管美国传染病学会指南建议不要对无症状菌尿症（ASB）进行常规筛查，但尿液培养（UC）通常仍被不加区分地开具，尤其是在留置导尿管的患者中。1,2 阳性 UC 可能使提供者难以忽视，从而导致对 ASB 的不必要的抗生素治疗。2,3 使用诊断管理策略将 UC 限制在具有阳性尿液分析（UA）的情况下，可以减少不适当的 UC，因为无脓尿表明不存在感染。4-6 我们使用准实验设计评估了实施 UA 与 UC 算法的关联（“反射干预”）对 UC 开具实践、诊断效率和 UTI 的影响。
