Trial reportInfection control and hospital epidemiology2021
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.
Trial report in Infection control and hospital epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The trial behind it
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Who cites it
17 citing papers in PubMed, 44 citations in OpenAlex.
- Not everyone is special: evaluation of indication in a urinalysis-driven reflex urine culture protocol at an academic medical center.Infection control and hospital epidemiology · 2026Article
- Charting new territory: outpatient stewardship in immunocompromised patients (first of a two-part series).Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Review
- Improving urine culture appropriateness and reducing unnecessary testing through education and feedback in a hospital setting.BMC infectious diseases · 2025Article
- Opportunities for collaboration: the synergy between antimicrobial and diagnostic stewardship in pediatrics.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Review
- Research agenda for antibiotic stewardship within the Veterans' Health Administration, 2024-2028.Infection control and hospital epidemiology · 2024Article
- Diagnostic stewardship in infectious diseases: a scoping review.Journal of medical microbiology · 2024Article
- Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics.Infection control and hospital epidemiology · 2024Article
- A decade of clinical microbiology: top 10 advances in 10 years: what every infection preventionist and antimicrobial steward should know.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Review
- Development and validation of an antimicrobial stewardship clinical decision-support tool to improve the management of urinary tract infections versus asymptomatic bacteriuria in hospitalized patients.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Implementing diagnostic stewardship to improve diagnosis of urinary tract infections across three medical centers: A qualitative assessment.Infection control and hospital epidemiology · 2023Article
- Antibiotic postprescribing modification opportunities among nursing home residents treated for urinary tract infection.Infection control and hospital epidemiology · 2023Article
- Leveraging diagnostic stewardship within antimicrobial stewardship programmes.Drugs in context · 2023Review
- Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections? A Systematic Review and Meta-Analysis.Open forum infectious diseases · 2023Article
- Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections.Antibiotics (Basel, Switzerland) · 2022Review
- Impact of provider-selected indication requirement on urine test utilization and positivity.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
- Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges.Current infectious disease reports · 2021Article
- A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2020.Open forum infectious diseases · 2021Review
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 1 country.
Funding
Abstract
objectiveIn the absence of pyuria, positive urine cultures are unlikely to represent infection. Conditional urine reflex culture policies have the potential to limit unnecessary urine culturing. We evaluated the impact of this diagnostic stewardship intervention.
designWe conducted a retrospective, quasi-experimental (nonrandomized) study, with interrupted time series, from August 2013 to January 2018 to examine rates of urine cultures before versus after the policy intervention. We compared 3 intervention sites to 3 control sites in an aggregated series using segmented negative binomial regression.
settingThe study included 6 acute-care hospitals within the Veterans' Health Administration across the United States.
participantsAdult patients with at least 1 urinalysis ordered during acute-care admission, excluding pregnant patients or those undergoing urological procedures, were included.
methodsAt the intervention sites, urine cultures were performed if a preceding urinalysis met prespecified criteria. No such restrictions occurred at the control sites. The primary outcome was the rate of urine cultures performed per 1,000 patient days. The safety outcome was the rate of gram-negative bloodstream infection per 1,000 patient days.
resultsThe study included 224,573 urine cultures from 50,901 admissions in 24,759 unique patients. Among the intervention sites, the overall average number of urine cultures performed did not significantly decrease relative to the preintervention period (5.9% decrease; P = 0.8) but did decrease by 21% relative to control sites (P < .01). We detected no significant difference in the rates of gram-negative bloodstream infection among intervention or control sites (P = .49).
conclusionsConditional urine reflex culture policies were associated with a decrease in urine culturing without a change in the incidence of gram-negative bloodstream infection.
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