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Urinalysis May Lead to Inappropriate Antibiotic Treatment

Positive urinalyses are associated with inappropriate antibiotic treatment among patients with suspected urinary tract infection (UTI), according to a recent study.
Findings from the study were presented at ID Week, which took place from October 4 to 8, 2017, in San Diego, California.
The urinalysis is one of the most readily available and cost-effective tests for diagnosing UTIs. However, problems can arise when antibiotics are prescribed to patients who do not display the usual signs and symptoms of a UTI and for whom a urinalysis was obtained for other reasons.
For their study, the researchers evaluated 1000 patients with positive urine nitrite. Subsequent analysis of urine culture and symptomatology was used to identify medical records. Data on age, sex, location (emergency room [ER] or hospital ward), findings on urinalysis, and antibiotic treatment were 
recorded and analyzed.
A total of 815 patients were excluded from the analysis, of whom 81 had missing data, 466 met exclusion criteria, and 268 had symptomatic UTI. However, 185 patients had no symptoms of UTI and were included in the analysis.
Results indicated that 108 patients (58.4%) had received inappropriate antibiotic treatment, which was significantly associated with higher levels of bacteria and white blood cells in the urinalyses. The researchers also noted that UTI had been much more likely to occur in the ER (n = 92 of 147) compared with hospital wards (n = 16 of 37).
Antibiotic treatment was not significantly associated with age, sex, urine pH, urine LE, or urine epithelial cell amounts. A total of 69.7% of patients did not have available urine cultures. However, following an assessment of available urine cultures, a positive urine culture was significantly associated with inappropriate antibiotic treatment. The most common presenting symptom had been psychiatric symptoms (21.6%) and vaginal bleeding (14.6%).
“Urinalysis can be an invaluable diagnostic tool, but must be used and interpreted appropriately,” the researchers concluded.
“There is a misperception that pyuria with bacteriuria 
defines UTI. However, positive results on a urinalysis alone in an asymptomatic patient is not enough to diagnose a UTI, and antibiotic treatment is only indicated in specific circumstances as outlined by IDSA guidelines for the treatment of asymptomatic bacteriuria. Further education targeting appropriate interpretation of urinalyses and IDSA guidelines is needed to decrease the unnecessary use of antibiotics.”

REFERENCE
Elshimy G, Mariano V, Joy CM, Kaur P, Singhal M. Are urinalyses used inappropriately in the diagnosis of urinary tract infections? Open Forum Infect Dis. 2017;4(Suppl 1):S350. https://doi.org/10.1093/ofid/ofx163.842.

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