Gabay Ohad, Cherki Tal, Tsaban Gal, Bichovsky Yoav, Nesher Lior
Infectious Disease Institute, Internal Medicine Division, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84101, Israel.
J Clin Med. 2022 Nov 27;11(23):7014. doi: 10.3390/jcm11237014.
: To assess the impact of changing the reporting threshold policy of positive urine cultures in hospitalized non-pregnant adults from 10 CFU/mL to 10 CFU/mL on the unwarranted use of antibiotics and patient safety. : A 1100-bed tertiary-care hospital in southern Israel. : As an intervention, we changed urine culture reporting policy for patients admitted to general medical wards. If culture grew ≥10 CFU/mL, it was reported with pathogen and antibiotic susceptibility data, if it grew ≤10 CFU/mL, it was reported as "low growth". The withheld information was available upon request. We retrospectively collected data on all patients in a four-month period following the intervention and report using STROBE guidelines. : 7808 patients were admitted, in whom 3523 urine cultures were obtained. A total of 496 grew a pathogen, 51 were excluded ( spp. positive, history of urinary surgery, obtained from catheter). A total of 300 were reported as positive and 145 were reported as low-growth. A higher rate of patients in the low-growth group were not treated with antibiotics 45/145(31%) vs. 56/300(18.7%) in the positive group = 0.015 and the antibiotic duration of treatment was shorter by day 5 (IQR 0.9) vs. 6 (IQR 0.9) = 0.015. No between-group difference was observed in recurrent admission rates, pyelonephritis within 30 days, bacteremia or all-cause mortality. : Changing the reporting threshold of positive urine culture results from 10 CFU/mL to 10 CFU/mL in hospitalized patients reduced the number of patients who were unnecessarily treated for asymptomatic bacteriuria without negatively impacting patient safety. We urge microbiological laboratories to consider this change in threshold as part of an antimicrobial stewardship program.
评估将住院非妊娠成年患者尿培养阳性报告阈值政策从≥10⁵ CFU/mL 更改为≥10³ CFU/mL 对不必要使用抗生素及患者安全的影响。
研究地点为以色列南部一家拥有1100张床位的三级医疗机构。
作为干预措施，我们改变了普通内科病房患者的尿培养报告政策。若培养结果≥10⁵ CFU/mL，则报告病原体及抗生素敏感性数据；若培养结果≤10³ CFU/mL，则报告为“低生长”。如需，可提供未报告的信息。我们回顾性收集了干预后四个月内所有患者的数据，并按照STROBE指南进行报告。
共收治7808例患者，其中3523例进行了尿培养。共496例培养出病原体，51例被排除（凝固酶阴性葡萄球菌阳性、有泌尿系统手术史、取自导尿管）。共300例报告为阳性，145例报告为低生长。低生长组未接受抗生素治疗的患者比例更高（45/145，31%），而阳性组为56/300（18.7%），P = 0.015；治疗第5天的抗生素使用疗程更短（四分位间距0.9），而阳性组为6天（四分位间距0.9），P = 0.015。在再入院率、30天内肾盂肾炎、菌血症或全因死亡率方面，两组间未观察到差异。
将住院患者尿培养阳性报告阈值从≥10⁵ CFU/mL 更改为≥10³ CFU/mL，减少了无症状菌尿不必要治疗的患者数量，且未对患者安全产生负面影响。我们敦促微生物实验室将此阈值变化作为抗菌药物管理计划的一部分予以考虑。
