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Urine Culture on Admission Impacts Antibiotic Use and Length of Stay: A Retrospective Cohort Study

Published online by Cambridge University Press:  27 March 2018

Molly J. Horstman ,
Andrew M. Spiegelman ,
Aanand D. Naik  and
Barbara W. Trautner
Molly J. Horstman*
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas VA Quality Scholars Coordinating Center, IQuESt, Michael E. DeBakey VA Medical Center, Houston, Texas
Andrew M. Spiegelman
Affiliation:
The Advisory Board Company, Washington, DC
Aanand D. Naik
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas VA Quality Scholars Coordinating Center, IQuESt, Michael E. DeBakey VA Medical Center, Houston, Texas
Barbara W. Trautner*
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas Department of Surgery, Baylor College of Medicine, Houston, Texas
*
Address correspondence to Molly J. Horstman, MD, Center for Innovations in Quality, Effectiveness, and Safety (152), 2002 Holcombe Boulevard, Houston, Texas 77030 (molly.horstman@bcm.edu) or Barbara Trautner, MD, PhD, Center for Innovations in Quality, Effectiveness, and Safety (152), 2002 Holcombe Boulevard, Houston, Texas 77030 (trautner@bcm.edu).
Address correspondence to Molly J. Horstman, MD, Center for Innovations in Quality, Effectiveness, and Safety (152), 2002 Holcombe Boulevard, Houston, Texas 77030 (molly.horstman@bcm.edu) or Barbara Trautner, MD, PhD, Center for Innovations in Quality, Effectiveness, and Safety (152), 2002 Holcombe Boulevard, Houston, Texas 77030 (trautner@bcm.edu).
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Abstract

OBJECTIVE

To examine the impact of urine culture testing on day 1 of admission on inpatient antibiotic use and hospital length of stay (LOS).

DESIGN

We performed a retrospective cohort study using a national dataset from 2009 to 2014.

SETTING

The study used data from 230 hospitals in the United States.

PARTICIPANTS

Admissions for adults 18 years and older were included in this study. Hospitalizations were matched with coarsened exact matching by facility, patient age, gender, Medicare severity-diagnosis related group (MS-DRG), and 3 measures of disease severity.

METHODS

A multilevel Poisson model and a multilevel linear regression model were used to determine the impact of an admission urine culture on inpatient antibiotic use and LOS.

RESULTS

Matching produced a cohort of 88,481 patients (n=41,070 with a culture on day 1, n=47,411 without a culture). A urine culture on admission led to an increase in days of inpatient antibiotic use (incidence rate ratio, 1.26; P<.001) and resulted in an additional 36,607 days of inpatient antibiotic treatment. Urine culture on admission resulted in a 2.1% increase in LOS (P=.004). The predicted difference in bed days of care between admissions with and without a urine culture resulted in 6,071 additional bed days of care. The impact of urine culture testing varied by admitting diagnosis.

CONCLUSIONS

Patients with a urine culture sent on day 1 of hospital admission receive more days of antibiotics and have a longer hospital stay than patients who do not have a urine culture. Targeted interventions may reduce the potential harms associated with low-yield urine cultures on day 1.

Infect Control Hosp Epidemiol 2018;39:547–554

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 547 - 554
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The findings in this manuscript were presented as a poster (#81) at the 2017 Society of Hospital Medicine Annual Meeting on May 2, 2017, in Las Vegas, Nevada. The abstract was a finalist in the poster competition.

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