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Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center

Published online by Cambridge University Press:  18 January 2016

Mohamed Sarg ,
Greer E. Waldrop ,
Mona A. Beier ,
Emily L. Heil ,
Kerri A. Thom ,
Michael Anne Preas ,
J. Kristie Johnson ,
Anthony D. Harris  and
Surbhi Leekha
Mohamed Sarg
Affiliation:
Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland
Greer E. Waldrop
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Mona A. Beier
Affiliation:
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Emily L. Heil
Affiliation:
Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland
Kerri A. Thom
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Michael Anne Preas
Affiliation:
Department of Infection Prevention, University of Maryland Medical Center, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Surbhi Leekha*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Address correspondence to Surbhi Leekha, MBBS, MPH, 110 S. Paca St, 6th Floor, Baltimore MD 21201 ([email protected]).
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Abstract

OBJECTIVE

To assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected.

DESIGN

Quasi-experimental study

SETTING

A 700-bed academic medical center

PATIENTS

Patients admitted to any adult ICU

METHODS

Aggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January–December 2012) and after the intervention (January–December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared.

RESULTS

Statistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed.

CONCLUSION

A change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams.

Infect. Control Hosp. Epidemiol. 2016;37(4):448–454

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 4 , April 2016 , pp. 448 - 454
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors with equal contribution; co-first authors.

References

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