To err on the side of caution, it has become routine practice for healthcare facilities to screen patients for urinary tract infections (UTIs), even those with no sign of infection, but it shouldn’t be. A study published in Infection Control and Hospital Epidemiology shows little evidence that testing patients automatically for UTI is beneficial and in fact tends to lead to unnecessary prescribing of antibiotics.
It’s well-known that bacteria in the bladder often leads to infection with symptoms characterized by fever, burning and pain during urination and a frequent urge to empty the bladder. In those cases, the best course of treatment is antibiotics. But some patients, namely elderly people or people with diabetes, host bacterial communities in their bladders that are considered harmless and do not require treatment.
Researchers at Washington University School of Medicine in St. Louis have concluded that slight changes made to the electronic system doctors rely on to order urine tests can reduce the number of bacterial culture tests ordered unnecessarily by almost 50 percent without causing any delay in identifying patients who truly need them. This simple modification, said the research team, encourages doctors to examine patients for UTI symptoms first instead of or before ordering a urine test. Doing so also cuts costs, reduces antibiotic resistance and other positive outcomes.
“Over-testing for UTIs drives up health-care costs and leads to unnecessary antibiotic use which spreads antibiotic resistance,” said senior author and infectious diseases specialist David K. Warren, MD, a professor of medicine. “Ordering tests when the patient needs them is a good thing. But ordering tests when it’s not indicated wastes resources and can subject patients to unnecessary treatment. We were able to reduce the number of tests ordered substantially without diminishing the quality of care at all, and at a substantial cost savings.”
Infectious disease professionals recommend looking for signs of UTI first, including administration of a urine dipstick test to detect inflammatory cells, before ordering a urinalysis.
Warren and his team introduced two changes to the way their colleagues at Barnes-Jewish Hospital ordered urine tests: They sent emails to clinicians explaining why urine dipstick tests makes sense as a first line of defense and also modified the electronic ordering system to default to a urine dipstick test followed by a bacterial culture test. Physicians could still order a urinalysis if they wanted but the process required taking an additional step in the system.
After the intervention, physicians ordered 45 percent fewer urine cultures over a 15-month period with a cost savings of $104,000 in lab costs alone.
“Everyone always worries that by ordering fewer urine cultures we might miss some UTIs, but we showed that we did not,” Warren said.
Learn more at Washington University School of Medicine in St. Louis.
