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. 2023 Dec;61(12):684-689.
doi: 10.1038/s41393-023-00938-7. Epub 2023 Nov 8.

Impact of routine urine cultures on antibiotic usage in those undergoing a routine annual spinal cord injury evaluation

Sarah May  1 , Annette Walder  2 , Casey Hines-Munson  2 , Ivy Poon  3 , S Ann Holmes  4 , Charlesnika T Evans  5   6 , Barbara W Trautner  1   2 , Felicia Skelton  7   8
Affiliations

Impact of routine urine cultures on antibiotic usage in those undergoing a routine annual spinal cord injury evaluation

Sarah May et al. Spinal Cord. 2023 Dec.

Abstract

Objective: The Veterans Health Administration (VHA), the largest single provider of spinal cord injury and disorder (SCI/D) care in the United States, currently mandates that every patient receives a screening urine culture during the annual evaluation, a yearly comprehensive history and physical examination. This testing has shown in a small subset of patients to overidentify asymptomatic bacteriuria that is then inappropriately treated with antibiotics. The objective of the current analysis was to assess the association of the annual evaluation on urine testing and antibiotic treatment in a national sample of Veterans with SCI/D.

Design/method: A retrospective cohort study using national VHA electronic health record data of Veterans with SCI/D seen between October 1, 2017-September 30, 2019 for their annual evaluation.

Results: There were 9447 Veterans with SCI/D who received an annual evaluation; 5088 (54%) had a urine culture obtained. 2910 cultures (57%) were positive; E. coli was the most common organism obtained (12.9% of total urine cultures). Of the patients with positive urine cultures, 386 were prescribed antibiotics within the 7 days after that encounter (13%); of the patients with negative cultures (n = 2178), 121 (6%) were prescribed antibiotics; thus, a positive urine culture was a significant driver of antibiotic use (p < 0.001).

Conclusion: The urine cultures ordered at the annual exam are often followed by antibiotics; this practice may be an important target for antibiotic stewardship programs in SCI.

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Conflict of interest statement

Conflict of Interest

No authors have any relevant financial conflicts of interest to this work.

Figures

Figure 1:
Figure 1:
Patient Flowchart describing urine cultures obtained during annual evaluation (AE) in cohort, positive urine culture classification, and antibiotic use.
Figure 2:
Figure 2:
(Panels A-D) Microbiology and Antibiotic Use
Figure 2:
Figure 2:
(Panels A-D) Microbiology and Antibiotic Use
See this image and copyright information in PMC

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