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Investigating Risk Factors for Urine Culture Contamination in Outpatient Clinics: A New Avenue for Diagnostic Stewardship.

ABSTRACT: Mixed flora in urine cultures usually occur due to pre-analytic contamination. In our outpatient urology clinic, we found a high prevalence of mixed flora (46.2%), which was associated with female sex and older age. Patient education did not impact the rate of mixed flora. Future efforts should target high-risk patients.

SUBMITTER: Whelan P

PROVIDER: S-EPMC9016366 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Investigating Risk Factors for Urine Culture Contamination in Outpatient Clinics: A New Avenue for Diagnostic Stewardship.

Whelan Patrick P Nelson Alicia A Kim Christopher J CJ Tabib Christian C Preminger Glenn G Turner Nicholas A NA Lipkin Michael M Advani Sonali D SD

Antimicrobial stewardship & healthcare epidemiology : ASHE 20220218 1

Mixed flora in urine cultures usually occur due to pre-analytic contamination. In our outpatient urology clinic, we found a high prevalence of mixed flora (46.2%), which was associated with female sex and older age. Patient education did not impact the rate of mixed flora. Future efforts should target high-risk patients. ...[more]

PMID: 35445218

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Project description:BackgroundAntimicrobial resistance is a global health threat. To slow resistance and preserve antibiotics, stewardship interventions are increasingly promoted and mandated. Urine cultures are the most common microbiological test in the outpatient setting. Contamination most likely occurs during urine collection from surrounding vaginal, perineal, and epidermal flora. Sample contamination can lead to incorrect diagnosis, unnecessary or inappropriate treatment, poor patient outcomes, and higher costs. Therefore, ensuring proper collection of urinary samples serves as a prime diagnostic stewardship target, one that international nursing societies increasingly endorse as an opportunity for nurse involvement.ObjectivesDetermine the prevalence, predictors, and antibiotic prescribing associated with contaminated urine cultures in primary care clinics.DesignCross-sectional study.SettingTwo adult safety-net clinics in Houston, Texas.Participants1265 clinical encounters among 1114 primary care patients.MethodsWe reviewed charts from office visits among patients who had a urine culture ordered between November 2018 and March 2020. Patient demographics, culture results and prescription orders were captured for each visit. Culture results were defined as no growth, contaminated (i.e., mixed flora, non-uropathogens, or ≥3 bacterial species isolated), or low-count (102-105 colony forming units (CFU)/mL) or high-count (>105 CFU/mL) uropathogen-positive. We performed multinomial logistic regression to identify predictors independently associated with contaminated cultures.ResultsOur study evaluated 1265 cultures from 1114 patients that were primarily female (84 %), of Hispanic/Latino (74.4 %) or Black/African American (18.9 %) race/ethnicity with a mean age of 43 years. Out of 1265 urine cultures, 264 (20.9 %) had no growth, 694 (54.9 %) were contaminated, 159 (12.6 %) were low-count positive, and 148 (11.7 %) were high-count positive. Female sex, pregnancy, and obesity were associated with contaminated cultures (multinomial adjusted odds ratios: 15.89, 14.34, 1.93, respectively; 95 % confidence intervals: 10.25-24.61, 8.03-25.61, 1.32-2.81, respectively). Antibiotic prescribing was significantly higher among symptomatic patients with contaminated cultures compared to those with no growth.ConclusionUrine culture contamination occurred frequently in our clinics, and obesity, female sex and pregnancy were independent risk factors for contamination. The association of pregnancy and contamination is particularly concerning as pregnant females are routinely screened and treated for asymptomatic bacteriuria in the United States. Culture contamination may obscure underlying uropathogens, leading to pyelonephritis or potential neonatal infection if untreated. Conversely, overtreatment of false positive bacteriuria could lead to adverse effects from antibiotics and increased risk for antibiotic resistance. As nurses play a prominent role in patient education, diagnostic stewardship interventions may want to utilize nurses' educational capabilities to improve urine culture collection.Tweetable abstract55 % of urine cultures collected in primary care clinics were contaminated, revealing a major opportunity for nurse-driven diagnostic stewardship interventions.

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Investigating Risk Factors for Urine Culture Contamination in Outpatient Clinics: A New Avenue for Diagnostic Stewardship.

Publications

Investigating Risk Factors for Urine Culture Contamination in Outpatient Clinics: A New Avenue for Diagnostic Stewardship.

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