Utility of Urine Cultures During Febrile Neutropenia Workup in Hematopoietic Stem Cell Transplantation Recipients Without Urinary Symptoms

Tran, Mya; Palmer, Shannon; Moore, Dominic T.; Bartelt, Luther A.; Friedland, A; Grgic, Tatjana; Lachiewicz, Anne; Ptachcinski, Jon; Seña, Arlene C.; Trepte, Morgan; Duin, David van; Andermann, Tessa M.; Shaw, J. Ryan

doi:10.1093/ofid/ofad236

Open Forum Infectious Diseases

2023

DOI: 10.1093/ofid/ofad236

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Utility of Urine Cultures During Febrile Neutropenia Workup in Hematopoietic Stem Cell Transplantation Recipients Without Urinary Symptoms

Mya Tran

Shannon Palmer

Dominic T. Moore

et al.

Abstract: The utility of obtaining screening urine cultures for febrile neutropenia (FN) during hematopoietic stem cell transplant (HCT) is unknown. In 667 adult HCT patients with FN, only 40 (6%) were found with bacteriuria. Antibiotics were modified in 3 patients (0.4%) based on urine cultures and none developed urinary-associated infectious complications.

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Impact of urinary culture on diagnosis and treatment strategy after empiric therapy in febrile neutropenic patients

Hata,

Ihara

2024

Acute Medicine & Surgery

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AimFebrile neutropenia (FN) is treated by a broad‐spectrum antimicrobial. Subsequent antimicrobial therapy depends on identifying the source of the infection. Although urinary tract infections (UTIs) are common and urine culture (UC) is a valuable diagnostic tool, uncertainties remain about the specific indications for conducting UC in FN. This study examined whether performing routine UC would affect the subsequent antimicrobial therapy in FN.MethodsAll emergency department patients who received chemotherapy for malignancy and met the definition of FN (neutrophil count <0.5 × 109/L and fever >37.5°C) were included. The patient's demographic data, clinical symptoms, urinalysis results, urine and blood culture results, antibiotic therapy and duration, and patient outcomes were extracted from electronic medical records. UC was defined as positive if >105 colony‐forming units/L were detected.ResultsIn total, 115 of the initial 124 cases were included in the analysis. Thirty‐one cases met the Infectious Diseases Society of America guideline definition for recommending UC (recommended group) and 84 cases did not (non‐recommended group). In the recommended group, 16 of 31 cases had a positive UC, and antibiotics were changed for nine, based on UC results. In the non‐recommended group, 15 of 84 cases had a positive UC, and antibiotics were changed for two. The same organism were identified in blood cultures. Seven of 115 cases were detected for the same pathogen in blood and urine cultures.ConclusionPerforming UC regardless of symptoms could diagnose several asymptomatic UTIs in FN, but seldom impact an antimicrobial treatment strategy.

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Impact of urinary culture on diagnosis and treatment strategy after empiric therapy in febrile neutropenic patients

Hata,

Ihara

2024

Acute Medicine & Surgery

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Antimicrobial Stewardship in Immunocompromised Patients

Hand,

Imlay

2023

Infectious Disease Clinics of North America

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When antimicrobial stewardship begins with microbiological test requests: the case of asymptomatic bacteriuria

Imlay,

Thorpe,

Vaughn

2024

Current Opinion in Infectious Diseases

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Purpose of review We aim to review the rationale, methods, and experiences with diagnostic stewardship targeted at urinary tract infection (UTI) and related urinary syndromes. Recent findings In the last 18 months, several articles have demonstrated the impact of diagnostic stewardship interventions at limiting inappropriate diagnosis of UTIs or inappropriate antibiotic-prescribing, targeting the urinary tract. Antimicrobial stewardship programs may create and implement interventions at the point of urine test ordering, urine test resulting, or at the point of prescribing antibiotics after results have returned. Specific design and implementation of stewardship interventions depends on context. To maximize their impact, interventions should be accompanied by education and garner buy-in from providers. Summary Diagnostic stewardship can decrease unnecessary antibiotics and inappropriate diagnosis of UTI with multifaceted interventions most likely to be effective. Remaining questions include how to reduce ASB treatment in new populations, such as those with immune compromise, and persistent unknowns regarding UTI diagnosis and diagnostics.

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Utility of Urine Cultures During Febrile Neutropenia Workup in Hematopoietic Stem Cell Transplantation Recipients Without Urinary Symptoms

Cited by 3 publications

References 11 publications

Impact of urinary culture on diagnosis and treatment strategy after empiric therapy in febrile neutropenic patients

Impact of urinary culture on diagnosis and treatment strategy after empiric therapy in febrile neutropenic patients

Antimicrobial Stewardship in Immunocompromised Patients

When antimicrobial stewardship begins with microbiological test requests: the case of asymptomatic bacteriuria

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