modified reporting of urine culture 817
figure 1. Participant Flow. table 1. Patient Demographics Variable
Age, mean y ±SD Females, no. (%)
Urinary tract infection, no. (%)
Asymptomatic bacteriuria, no. (%)
Standard Reporting (n=55)
68.6±16.0 36/55 (64.5) 14/55 (25.4)
41/55 (74.5)
Modified Reporting (n=55)
67.7±16.3 35/55 (63.6) 20/55 (36.3)
35/55 (63.6)
Most inpatients received many courses of antibiotics for various reasons during admission, so this difference reflects a small proportion of total antibiotic cost. Total length of stay was 45.9 ± 44.6 days in the standard reporting arm, compared to 34.9 ± 46.7 days in the modified reporting arm (mean length of stay reduction = 11.0 days per episode (P = .22). Total length of stay in patients treated appropriately for UTI/ASB was 30.1 ± 41.5 days, compared to 59.6 ± 47.7 days in patients treated inappropriately for UTI/ ASB (mean length of stay reduction, 29.5 days per episode; P = .001).
in both arms. Most new symptoms were unrelated to urinary tract infection (Supplementary Table 4).
Cost
The mean cost of antibiotic treatment given for UTI/ASB was $35.78 ± $109.77 in the standard reporting arm (36 pre- scriptions given to 53 patients), compared to $19.84 ± 64.88 in the modified reporting arm (27 prescriptions given to 53 patients) (mean cost savings, $14.94 per episode; P = .37).
discussion
We have demonstrated that modified urine-culture reporting is associated with a significant reduction in inappropriate treatment, without an increase in adverse events. An increase in empiric UTI treatment was not observed. Other multi- faceted interventions significantly reduced treatment of ASB among inpatients7 and among catheterized patients8; however, these interventions require considerable ongoing effort3 compared to changing laboratory policy.
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