退伍军人事务医院急诊科尿液分析对反射培养过程变化的影响评估。

U. Patel, G. Ismail, K. Suda, Rabeeya K. Sabzwari, S. Pacheco, S. Bhoopalam
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引用次数: 5

摘要

背景尽管在急诊科(ED)经常使用尿液分析(UA)后的自动尿液培养(UC)来识别尿路感染(UTI),但据报道,结果往往是没有生物体生长或临床上不重要的生物体生长,导致无症状菌尿(ASB)的过度检测和过度治疗。方法在美国退伍军人事务部医疗中心ED实施流程变更,如果UA每高功率场(WBC/HPF)有<5个白细胞,该中心会自动取消UC。不取消(DNC)UC的选项可用。前瞻性收集实施后3个月的数据,包括UA/UC结果、UTI症状的存在、处方抗生素和医疗保健使用情况。结果干预后,684个UA(37.2%)从ED就诊中得到评估。干预后,在255个UA中,95个(37.3%)UC取消呈阴性,95个处理UC呈阳性,43个(16.9%)被指定为DNC,22个(8.6%)被取消UC。尽管UA呈阴性,但UC处理率从干预前的100%显著降低到干预后的38.6%(P<.001)。ASB抗生素处方不当从干预前10.2%降低到干预前1.9%(比值比=0.17;P=.01)。在UA标本呈阴性的患者中,抗生素处方在干预后减少了25.3%。在首次UA介入治疗后的7天内,未发现有症状的UTI的门诊、ED或医院就诊报告。结论UA到反射培养过程的改变显著减少了不适当的UC的处理和ASB不必要的抗生素使用。没有遗漏尿路感染或其他不良患者结局。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluating the Impact of a Urinalysis to Reflex Culture Process Change in the Emergency Department at a Veterans Affairs Hospital.
Background Although automated urine cultures (UCs) following urinalysis (UA) are often used in emergency departments (EDs) to identify urinary tract infections (UTIs), results are often reported as no organism growth or the growth of clinically insignificant organisms, leading to the overdetection and overtreatment of asymptomatic bacteriuria (ASB). Methods A process change was implemented at a US Department of Veterans Affairs medical center ED that automatically cancelled UCs if UAs had < 5 white blood cells per high-power field (WBC/HPF). An option for do not cancel (DNC) UC was available. Data were prospectively collected for 3 months postimplementation and included UA/UC results, presence of UTI symptoms, antibiotics prescribed, and health care utilization. Results Postintervention, 684 UAs (37.2%) were evaluated from ED visits. Postintervention, of 255 UAs, 95 (37.3%) were negative with UC cancelled, 95 (37.3%) were positive with UC processed, 43 (16.9%) were ordered as DNC, and 22 (8.6%) were ordered without a UC. UC processing despite a negative UA significantly decreased from 100% preintervention to 38.6% postintervention (P < .001). Inappropriate prescribing of antibiotics for ASB was reduced from 10.2% preintervention to 1.9% postintervention (odds ratio = 0.17; P = .01). In patients with negative UA specimens, antibiotic prescribing decreased by 25.3% postintervention. No reports of outpatient, ED, or hospital visits for symptomatic UTI were found within 7 days of the initial UA postintervention. Conclusions The UA to reflex culture process change resulted in a significant reduction in processing of inappropriate UCs and unnecessary antibiotic use for ASB. There were no missed UTIs or other adverse patient outcomes.
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