Kimberly C Claeys1, Barbara W Trautner2, Surbhi Leekha3, K C Coffey4, Christopher J Crnich5, Dan J Diekema6, Mohamad G Fakih7, Matthew Bidwell Goetz8, Kalpana Gupta9, Makoto M Jones10, Luci Leykum11, Stephen Y Liang12, Lisa Pineles13, Ashley Pleiss14, Emily S Spivak15, Katie J Suda16, Jennifer M Taylor17, Chanu Rhee18, Daniel J Morgan19. 1. Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA. 2. Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. 3. Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA. 4. Division of Infectious Diseases, VA Maryland Healthcare System, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. 5. Division of Internal Medicine, William S. Middleton Memorial Veterans Hospital, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA. 6. Division of Infectious Diseases, University of Iowa Carver College of Medicine, University of Iowa Health Care, Iowa City, Iowa, USA. 7. Quality Department, Clinical & Network Services, Ascension Healthcare, Grosse Pointe Woods and Wayne State University School of Medicine, Detroit, Michigan, USA. 8. Section of Infectious Diseases, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA. 9. Division of Infectious Diseases, VA Boston Healthcare System, and Boston University School of Medicine, Boston, Massachusetts, USA. 10. Division of Epidemiology, Salt Lake City Veterans Affairs Healthcare System, University of Utah, Salt Lake City, Utah, USA. 11. Department of Internal Medicine, University of Texas at Austin Dell School of Medicine, Austin, Texas, USA. 12. Division of Infectious Diseases, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA. 13. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. 14. Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland, USA. 15. Department of Medicine, Veterans Affairs Healthcare System, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. 16. Division of General Internal Medicine, VA Pittsburgh Healthcare System, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA. 17. Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA. 18. Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. 19. Division of Infectious Diseases, VA Maryland Healthcare System, Department of Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Urine cultures are nonspecific and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. In this study, we aimed to develop expert guidance on best practices for urine culture diagnostic stewardship. METHODS: A RAND-modified Delphi approach with a multidisciplinary expert panel was used to ascertain diagnostic stewardship best practices. Clinical questions to guide recommendations were grouped into three thematic areas (ordering, processing, reporting) in practice settings of emergency department, inpatient, ambulatory, and long-term care. Fifteen experts ranked recommendations on a 9-point Likert scale. Recommendations on which the panel did not reach agreement were discussed during a virtual meeting, then a second round of ranking by email was completed. After secondary review of results and panel discussion, a series of guidance statements was developed. RESULTS: One hundred and sixty-five questions were reviewed. The panel reaching agreement on 104, leading to 18 overarching guidance statements. The following strategies were recommended to optimize ordering urine cultures: requiring documentation of symptoms, sending alerts to discourage ordering in the absence of symptoms, and cancelling repeat cultures. For urine culture processing, conditional urine cultures and urine white blood cell count as criteria were supported. For urine culture reporting, appropriate practices included nudges to discourage treatment under specific conditions and selective reporting of antibiotics to guide therapy decisions. CONCLUSIONS: These 18 guidance statements can optimize use of urine cultures for better patient outcomes. Published by Oxford University Press for the Infectious Diseases Society of America 2021.
BACKGROUND: Urine cultures are nonspecific and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. In this study, we aimed to develop expert guidance on best practices for urine culture diagnostic stewardship. METHODS: A RAND-modified Delphi approach with a multidisciplinary expert panel was used to ascertain diagnostic stewardship best practices. Clinical questions to guide recommendations were grouped into three thematic areas (ordering, processing, reporting) in practice settings of emergency department, inpatient, ambulatory, and long-term care. Fifteen experts ranked recommendations on a 9-point Likert scale. Recommendations on which the panel did not reach agreement were discussed during a virtual meeting, then a second round of ranking by email was completed. After secondary review of results and panel discussion, a series of guidance statements was developed. RESULTS: One hundred and sixty-five questions were reviewed. The panel reaching agreement on 104, leading to 18 overarching guidance statements. The following strategies were recommended to optimize ordering urine cultures: requiring documentation of symptoms, sending alerts to discourage ordering in the absence of symptoms, and cancelling repeat cultures. For urine culture processing, conditional urine cultures and urine white blood cell count as criteria were supported. For urine culture reporting, appropriate practices included nudges to discourage treatment under specific conditions and selective reporting of antibiotics to guide therapy decisions. CONCLUSIONS: These 18 guidance statements can optimize use of urine cultures for better patient outcomes. Published by Oxford University Press for the Infectious Diseases Society of America 2021.
Authors: Andrea Romano; Sun-Wei Guo; Jan Brosens; Asgerally T Fazleabas; Caroline Gargett; Stefan Giselbrecht; Martin Goette; Linda Griffith; Hugh S Taylor; Robert N Taylor; Hugo Vankelecom; Charles Chapron; Xiaohong Chang; Khaleque N Khan; Paola Vigano' Journal: Reprod Fertil Date: 2022-07-01