ArticleOpen forum infectious diseases2017
Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis.
Article in Open forum infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers.
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Who cites it
54 citing papers in PubMed.
- Conditional reflex to urine culture: Evaluation of a diagnostic stewardship intervention within the Veterans' Affairs and Centers for Disease Control and Prevention Practice-Based Research Network.Infection control and hospital epidemiology · 2021Trial
- Use of microbiology tests in the era of increasing AMR rates- a multicentre hospital cohort study.Antimicrobial resistance and infection control · 2019Trial
- Trends in microbiology testing in Australian long-term care facilities: national cohort study.BMC infectious diseases · 2026Article
- Emergency medicine physicians treating urine cultures when it is not clear they should.Clinical and experimental emergency medicine · 2026Article
- Clinical factors and diagnoses associated with inappropriate urine culture ordering in primary care.Infection control and hospital epidemiology · 2026Article
- Impact of a structured urine culture request form on antimicrobial stewardship in urinary tract infections at a tertiary care hospital in India.Frontiers in antibiotics · 2026Article
- A stepwise antimicrobial and diagnostic stewardship intervention for ordering urine cultures in Saudi Arabia: a quasi-experimental study.Frontiers in cellular and infection microbiology · 2026Article
- Article
- Targeting Overtreatment of Asymptomatic Bacteriuria in the Emergency Department: Results from a Quasi-Experimental Clinical Pharmacist-Led Program Based on Education and Audit.Antibiotics (Basel, Switzerland) · 2025Article
- Impact of Diagnostic Stewardship on Urine Culture Ordering in Saudi Arabia: Prospective Pre- and Postintervention Study.JMIR medical informatics · 2025Article
- Guideline Adherence of Asymptomatic Bacteriuria Management Among Physicians in Jordan: A Cross-sectional Study.Open forum infectious diseases · 2025Article
- Prevalence of Urine Culture Contamination in a Primary Care Outpatient Setting in Muscat, Oman:Sultan Qaboos University medical journal · 2025Article
- Exploring the association between the degree of pyuria and urinary tract infections.Microbiology spectrum · 2025Article
- The role of pharmacological interventions in managing urological complications during pregnancy and childbirth: A review.Medicine · 2025Review
- Greening Infection Prevention and Control: Multifaceted Approaches to a Sustainable Future.Open forum infectious diseases · 2025Article
- A urinalysis to urine culture reflex protocol results in high rates of asymptomatic bacteriuria treatment.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Use of BacterioScan 216Dx to reduce antibiotic use for suspected urinary tract infection in the emergency department.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Influence of a microbiological commentary on the management of asymptomatic bacteriuria.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Performance of Gram Stain, Leukocyte Esterase, and Nitrite in Predicting the Presence of Urinary Tract Infections: A Diagnostic Accuracy Study.Archives of academic emergency medicine · 2025Article
- Feasibility of Licensed Vocational Nurses Using a CDS App to Communicate Signs and Symptoms of a UTI.Nursing research and practice · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMismanagement of asymptomatic patients with positive urine cultures (referred to as asymptomatic bacteriuria [ASB] in the literature) promotes antimicrobial resistance and results in unnecessary antimicrobial-related adverse events and increased health care costs.
methodsWe conducted a systematic review and meta-analysis of studies that reported on the rate of inappropriate ASB treatment published from 2004 to August 2016. The appropriateness of antimicrobial administration was based on guidelines published by the Infectious Diseases Society of America.
resultsA total of 2142 nonduplicate articles were identified, and among them 30 fulfilled our inclusion criteria. The pooled prevalence of antimicrobial treatment among 4129 cases who did not require treatment was 45% (95% CI, 39-50). Isolation of gram-negative pathogens (odds ratio [OR], 3.58; 95% CI, 2.12-6.06), pyuria (OR, 2.83; 95% CI, 1.9-4.22), nitrite positivity (OR, 3.83; 95% CI, 2.24-6.54), and female sex (OR, 2.11; 95% CI, 1.46-3.06) increased the odds of receiving treatment. The rates of treatment were higher in studies with ≥100 000 cfu/mL cutoff values compared with <10 000 cfu/mL for bacterial growth (
conclusionThe mismanagement of ASB remains extremely frequent. Female sex and the overinterpretation of certain laboratory data (positive nitrites, pyuria, isolation of gram-negative bacteria and cultures with higher microbial count) are associated with overtreatment. Even simple stewardship interventions can be particularly effective, and antimicrobial stewardship programs should focus on the challenge of differentiating true urinary tract infection from ASB.
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