Diagnostic stewardship for urinary tract infection: A snapshot of the expert guidance

Article Figures & Data

TABLE 1

Ordering, processing, and reporting urine cultures: Key points of the expert guidance

Stage	Appropriate practices
Ordering	Require documentation of proper (eg, clean-catch) collection Only test patients with documented signs and symptoms of urinary tract infection
Processing	Use a reflex-culture protocol when possible, so urine without inflammatory markers (ie, white blood cells) is not cultured, as this helps prevent microbial characterization and inappropriate treatment of asymptomatic bacteriuria Do not routinely work up any isolates when more than 2 types of bacteria are recovered by culture
Reporting	Optimize laboratory reporting: Include a disclaimer that high colony counts can be present in asymptomatic bacteriuria “Nudge” prescribers not to treat asymptomatic bacteriuria or mixed growth Clearly define identified isolates as uropathogen or probable skin contaminant Use antibiotic cascade reporting, which does not report fluoroquinolones as first-line antibiotics

TABLE 2

Ordering urine cultures: Appropriate and inappropriate signs and symptoms to document

Urinary catheter status	Appropriate sign or symptom	Inappropriate sign
Patient without a urinary catheter	Dysuria, suprapubic pain, flank pain, costovertebral angle tenderness, septic shock	Altered mental status, change in urine characteristics
Patient with a urinary catheter	Dysuria, suprapubic pain, flank pain, costovertebral angle tenderness, or septic shock	Change in urine characteristics