Improving urine testing stewardship with a technology-leveraged urine testing guideline

Area of Science:

• Clinical Informatics
• Diagnostic Stewardship
• Antimicrobial Resistance

Background:

• Unnecessary urine cultures lead to antibiotic overuse, antimicrobial resistance, and Clostridioides difficile infections.
• Asymptomatic bacteriuria is often misclassified as infection, driving inappropriate testing.

Purpose of the Study:

• To evaluate the impact of an electronic medical record (EMR)-integrated, algorithm-based best practice alert (BPA) on diagnostic stewardship for urine testing in hospitalized adults.
• To assess the effect of the BPA on urine culture and pan-culturing rates.
• To monitor for potential safety concerns, such as changes in gram-negative rod bacteremia.

Main Methods:

• A prospective quality improvement study at a tertiary care hospital.
• An algorithm-based BPA was embedded in the EMR to guide urine testing orders.
• Urine culture and pan-culturing rates were compared pre- and post-intervention using interrupted time series analysis.

Main Results:

• Urine testing decreased by 31.6% and pan-culturing by 22.2% post-intervention (P < .01).
• Interrupted time series analysis indicated sustained downward trends in testing and culturing.
• Catheter-associated urinary tract infection (CAUTI) and gram-negative rod bacteremia rates remained stable, with no adverse safety signals.

Conclusions:

• An EMR-integrated BPA effectively reduced unnecessary urine testing and pan-culturing.
• The intervention coincided with existing downward trends and showed no negative impact on patient safety.
• Continued monitoring is essential to maintain appropriate use and adoption of the BPA.