Impact of Diagnostic Stewardship on Urine Culture Ordering in Saudi Arabia: Prospective Pre- and Postintervention Study.

BACKGROUND

Inappropriate testing of urine cultures can lead to overuse of antibiotics, antimicrobial resistance, Clostridioides difficile infections, and increased cost. In Saudi Arabia, antimicrobial stewardship programs have improved antibiotic use but lack focus on asymptomatic bacteriuria. Targeted interventions are needed to address this gap.

OBJECTIVE

We assessed the implementation of a clinical decision support (CDS) tool in diagnostic stewardship, focusing on the appropriateness of urine culture orders and antibiotic use.

METHODS

We examined differences in urine culture testing and antibiotic use before and after implementation of a CDS tool in a 400-bed hospital in Riyadh, Saudi Arabia, from August 2021 to July 2022. We included adult patients with urine culture orders. Our outcomes were the percentage of urine cultures ordered that were inappropriate and antibiotic use after the implementation of the CDS intervention. We used a multivariable logistic regression model to determine factors associated with inappropriate urine culture testing and antibiotic use.

RESULTS

The percentage of inappropriate urine culture orders were significantly lower in the postintervention period compared to the preintervention period (821/2254, 36.4% vs 754/1814, 41.6%; P=.001). The CDS intervention was associated with 16.7% lower odds of inappropriate urine culture ordering (adjusted odds ratio [aOR] 0.83, 95% CI 0.73-0.95; P=.008). Unnecessary antibiotics were significantly lower in the postintervention period (310/2254, 72.9% vs 288/1814, 85.7%; P<.001). The CDS intervention was associated with a 52% reduction in unnecessary antibiotic use (aOR 0.487, 95% CL 0.332-0.713; P<.001).

CONCLUSIONS

A CDS initiative can reduce unnecessary urine culture testing and antibiotic overuse.