Optimizing Reflex Urine Cultures: Using a Population-Specific Approach to Diagnostic Stewardship

There were 221,933 encounters during the 6-year period; 10% were catheterized, 29% were positive, 30.7% were negative. No single UA parameter had high sensitivity and high specificity. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. In terms of NPV, combined UA parameters did not perform better than pyuria alone. The high NPV >=0.90 of pyuria was maintained among most patient age and sex subgroups with the exception of females ≥65 and patients with indwelling catheters. UA parameters should be leveraged for their NPV instead of sensitivity, when used as a part of diagnostic workup. Future reflex urine culture workflows and diagnostic stewardship algorithms should incorporate population-specific UA criteria and/or focus on populations where NPV of pyuria is high.

2021 SHEA Research Scholar Award
Advani SD, Turner NA, Schmader KE, Wren RH, Moehring RW, Polage CR, Vaughn V, Anderson D. Optimizing Reflex Urine Cultures: Using a Population-Specific Approach to Diagnostic Stewardship. Abstract 1261422.