Deconstructing the urinalysis: A novel approach to diagnostic and antimicrobial stewardship

Abstract

The extensive use of the urinalysis for screening and monitoring in diverse clinical settings usually identifies abnormal urinalysis parameters in patients with no suspicion of urinary tract infection, which in turn triggers urine cultures, inappropriate antimicrobial use, and associated harms like Clostridioides difficile infection. We highlight how urinalysis is misused, and suggest deconstructing it to better align with evolving patterns of clinical use and the differential diagnosis being targeted. Reclassifying the urinalysis components into infectious and non-infectious panels and interpreting urinalysis results in the context of individual patient’s pretest probability of disease is a novel approach to promote proper urine testing and antimicrobial stewardship, and achieve better outcomes.

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications for Hospitalized Patients in 2021

“…Despite recommendations against treatment, up to 65% of patients with ASB receive antibiotic therapy [ 23 ]. Given the frequency with which antibiotics are prescribed for ASB and its designation as an “antibiotic-never event,” ASPs have investigated which interventions might reduce this harmful practice [ 24 , 25 ]. Rico and colleagues evaluated the impact of an AS bundle to reduce unnecessary antibiotics in patients with ASB [ 26 ].…”

Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship

“…Low-level bacteriuria on urinalysis also had a high NPV; however, the presence of bacteria on urinalysis cannot discriminate between viable or nonviable organisms and pathogenic or nonpathogenic organisms. 8 Hence, presence of bacteria on urinalysis, despite its high NPV, should not be used as a single inclusion or exclusion criteria in reflex urine cultures. Additionally, as combination urinalysis parameters did not perform better than pyuria alone, it is unclear what utility, if any, bacteria on urinalysis will serve in the future.…”

Combined Training Intervention Targeting Medical and Nursing Staff Reduces Ciprofloxacin Use and Events of Urinary Tract Infection

“…In a study by Lim et al on nurses` knowledge, perception, and practice around urinalysis, performing urinalysis on all new admissions was identified as routine practice by 89% and 35% of patients with indwelling catheters [ 12 ]. However, due to predictable colonization, the inappropriateness of urinalysis from indwelling catheters, especially in the absence of clinical symptoms of UTI, is key aspect of ASP and a focus of our training presentations [ 13 , 14 ]. In the last three years, the request for urine cultures from indwelling catheters rose heavily at UKW.…”