Infection Control & Hospital Epidemiology
Table 2. Characteristics of Patients With ≥1 Urine Cultures Obtained From Inpatients Variable
Study Cohorta (N=18,954), No. (%)
Age, median (IQR)
Race White Black Other
Sex Male Female Median urine culture per admission (range)
Discharge statusd Discharged to home
Discharged to other facility Other
9,040 (47.7) 9,914 (52.3) 1 (1–12)
12,336 (65.6) 4,805 (25.5) 1,670 (8.9)
5,702 (48.4) 6,078 (51.6) 1 (1–12)
7,762 (66.6) 2,890 (24.8) 999 (8.6)
3,338 (46.5) 3,836 (53.5) 1 (1–12)
4,574 (63.9) 1,915 (26.7) 671 (9.4)
.012 Reference 62 (49–72)
13,043 (68.8) 4,791 (25.3) 1,120 (5.9)
283
Preintervention (N=11,780), No. (%)b
61 (48–72)
8,098 (68.7) 2,926 (24.8) 756 (6.4)
Postintervention (N=7,174), No. (%)c
62 (49–72)
4,945 (68.9) 1,865 (26.0) 364 (5.1)
P Value .015
Reference .217
<.001
<.001
Reference .815
Note. IQR, interquartile range. aEach admission is treated as an observation for this analysis purpose. Study cohort includes patients admitted to hospital whose urine was tested (≥1) for culture at the hospital during the study period (does not include urine cultures performed at the emergency department, a 24/7 clinic, or in any outpatient setting). Overall, 18,954 patient admissions contributed to 24,569 urine
culture tests during the study period (median, 1; IQR, 1–1). bJanuary 2015 to April 2016. cMay 2016 to August 2017. dOverall: missing (n=143); other: still in hospital (n=9); died (n=1,532); left against advice (n= 106); unknown (n=23). Preintervention: missing (n =129); still in hospital (n =5); admitted to hospital (n=12); died (n=910); left against advice (n =72); Postintervention: missing (n=14); still in hospital (n =4); died (n =622); left against advice (n=34); unknown (n =11).
Table 3. Comparison of Urine Culture Testing Practices Before and After the Intervention Variable
Positive cultures, No. (%)c Isolated cultures, No. (%)c
Urine cultures per 1,000 patient daysd
Catheterized urine cultures per 1,000 patient days Catheter associated UTI, No. (%) CAUTI per 1,000 patient days CAUTI per 1,000 catheter days
Total (n=24,569) 6,642 (27.0) 6,240 (25.4) 29.4 4.8
250 (1.0) 0.30 1.26
Preintervention (n=15,746)a 4,021 (25.5) 4,101 (26.0) 38.1 7.8
125 (0.8) 0.30 1.25
Postintervention (n=8,823)b 2,621 (29.7) 2,139 (24.2) 20.9 1.9
125 (1.4) 0.30 1.27
Note: UTI, urinary tract infection; CAUTI, catheter associated urinary tract infection. aJanuary 2015 to April 2016. bMay 2016 to August 2017. cSee methods for definitions. dBased upon 413,137 patient days preintervention and 421,714 patient days postintervention for all patients admitted to the hospital during the study period (see Methods).
rate of $15.00 per urine culture (not adjusted to inflation).24 Total laboratory charges for urine cultures during the preintervention and postintervention periods were calculated, and cost difference was estimated.
Statistical analysis
Patient demographics and characteristics are reported on a per- admission basis. Urine cultures rates are reported per 1,000 patient days (ie, the total patient days for all patients admitted during the study period). CAUTI rates are reported per 1,000 patient days and catheter days. Demographic characteristics and urine culture data were compared for the preintervention period and the postinter- vention period using the Wilcoxon rank-sum test, χ2 test, or univariable logistic regression where appropriate. An interrupted time-series model was used to analyze the impact of the interven- tion on urine culture rates during the study period. Data were
analyzed using SAS version 9.3 software (SAS Institute, Cary, NC). The Washington University Human Research Protection Office approved this study.
Results Patient characteristics
During the study period, 18,954 patients had ≥1urine culture ordered during their hospital stay (11,780 during the preinterven- tion vs 7,174 during the postintervention period) (Table 2). The median age of the patients was 62 years; ~69% of patients were white and 52.3% were female. Also, ~66% of these patients were routinely discharged home and 25.5% were discharged to or transferred to other facilities. Patients in the preintervention period were slightly younger (61 years preintervention vs 62 years postintervention; P =.015), were predominantly male (48.4% vs
P Value <.001 .002
<.001 <.001
.871 .899
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