ArticleInfection control and hospital epidemiology2023
Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship.
Article in Infection control and hospital epidemiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 25 citations in OpenAlex.
- Emerging Technologies for the Diagnosis of Urinary Tract Infections: Advances in Molecular Detection and Resistance Profiling.Diagnostics (Basel, Switzerland) · 2025Review
- Improving Urinary Tract Infection Diagnostics in Oncology: Reliability of Reflex Urine Culture in Immunosuppressed Neutropenic and Non-neutropenic Cancer Patients.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Novel technologies for the diagnosis of urinary tract infections.Journal of clinical microbiology · 2025Review
- Ancillary Benefit of Microbiology Culture Diagnostic Stewardship: Decreasing Health Care's Climate Impact.Open forum infectious diseases · 2025Article
- Performance of Urinalysis Parameters in Predicting Urinary Tract Infection: Does One Size Fit All?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department.International journal of emergency medicine · 2024Article
- Positive predictive value of urine analysis with reflex criteria at a large community hospital.International urogynecology journal · 2024Article
- Effect of automated identification of antimicrobial stewardship opportunities for suspected urinary tract infections.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Evaluation of Two Tests for the Rapid Detection of CTX-M Producers Directly in Urine Samples.Antibiotics (Basel, Switzerland) · 2023Article
- Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update.Infection control and hospital epidemiology · 2023Article
- De-implementation strategy to reduce overtreatment of asymptomatic bacteriuria in the emergency department: a stepped-wedge cluster randomised trial.Therapeutic advances in infectious diseaseArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundClinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations.
methodsIn this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL).
resultsIn 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters.
conclusionWhen used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.