TY - JOUR
T1 - Optimal Urine Culture Diagnostic Stewardship Practice - Results from an Expert Modified-Delphi Procedure
AU - Claeys, Kimberly C.
AU - Trautner, Barbara W.
AU - Leekha, Surbhi
AU - Coffey, K. C.
AU - Crnich, Christopher J.
AU - Diekema, Dan J.
AU - Fakih, Mohamad G.
AU - Goetz, Matthew Bidwell
AU - Gupta, Kalpana
AU - Jones, Makoto M.
AU - Leykum, Luci
AU - Liang, Stephen Y.
AU - Pineles, Lisa
AU - Pleiss, Ashley
AU - Spivak, Emily S.
AU - Suda, Katie J.
AU - Taylor, Jennifer M.
AU - Rhee, Chanu
AU - Morgan, Daniel J.
N1 - Publisher Copyright:
© 2021 Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - 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.
AB - 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.
KW - diagnostic stewardship
KW - expert consensus
KW - modified Delphi
KW - urinary tract infection
KW - urine cultures
UR - http://www.scopus.com/inward/record.url?scp=85124828500&partnerID=8YFLogxK
U2 - 10.1093/cid/ciab987
DO - 10.1093/cid/ciab987
M3 - Article
C2 - 34849637
AN - SCOPUS:85124828500
SN - 1058-4838
VL - 75
SP - 382
EP - 389
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -