The following is a summary of “Urine culture practices for complicated urinary tract infections in an academic emergency department,” published in the June 2023 issue of Emergency Medicine by Sorensen, et al.

For a study, researchers sought to assess the ordering practices for urine cultures in patients with complicated UTIs (cUTIs) and their impact on patient outcomes in an academic hospital setting.

A retrospective chart review was conducted on adult patients aged 18 years and older with cUTIs diagnosed in a single academic emergency department. A total of 398 patient encounters between January 1, 2019, and June 30, 2019, were included based on ICD-10 diagnosis codes consistent with cUTI. The definition of cUTI consisted of thirteen subgroups derived from existing literature and guidelines. The primary outcome was the frequency of urine culture orders for cUTI patients. Additionally, the impact of urine culture results was assessed, and clinical course severity and readmission rates were compared between patients who received urine cultures and those who did not.

Of the 398 potential cUTI visits based on ICD-10 codes, 330 (82.9%) met the study inclusion criteria for cUTI. However, clinicians failed to obtain urine cultures in 92 (29.8%) cUTI encounters. Among the 217 cUTI patients with urine cultures, the results showed that 55.8% demonstrated sensitivity to the original treatment, 4.6% required a change in antimicrobial coverage, 22.6% had contaminated cultures, and 13.4% showed insignificant growth. Patients who received urine cultures had higher rates of admission to both ED observations (33.2% vs 16.3%, P = 0.003). The hospital (41.9% vs. 23.8%, P = 0.003) compared to those with missed cultures and admitted cUTI patients who underwent urine cultures had a longer hospital stay (3.23 vs 1.53 days, P < 0.001). The 30-day readmission rates for patients with cUTI discharged from the ED were 4.0% for those with urine cultures and 7.3% for those without urine cultures (P = 0.155).

The study revealed that over a quarter of cUTI patients did not receive a urine culture. Further investigations were needed to determine whether improving adherence to urine culturing practices for cUTIs will impact clinical outcomes.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001705