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

Spinal Cord, 2023 · DOI: 10.1038/s41393-023-00938-7 · Published: December 1, 2023

Simple Explanation

This study looks at whether routine urine cultures during annual checkups for veterans with spinal cord injuries lead to more antibiotic use. The researchers found that doing these urine tests often results in veterans getting antibiotics, even when they might not need them. The study suggests that hospitals and clinics should think about changing their policies to avoid unnecessary antibiotic use in these patients.

Study Duration

2 Years

Participants

9447 Veterans with SCI/D

Evidence Level

Retrospective cohort study

Key Findings

1
Over half (54%) of the cohort received a urine culture during their annual exam visit, of whom 57% (2910) had a positive culture.
2
Escherichia coli was the most common isolate on culture (32% of cultures).
3
Black (vs White) patients were more likely to have a urine culture performed.

Research Summary

This study shows that performing routine urine cultures resulted in increased unnecessary antibiotic treatment. This study emphasized the importance of patient and health care professional education on judicious stewardship of antibiotics Urine cultures at the annual exam appear to be driving antibiotic use, so minimizing urine testing remains a high-value antibiotic stewardship intervention target.

Practical Implications

Antibiotic Stewardship Programs

The practice of ordering urine cultures at annual exams and subsequent antibiotic prescriptions should be a target for antibiotic stewardship programs in SCI.

Education

There is a need for patient and healthcare professional education on judicious antibiotic stewardship.

Health Equity

Further inquiry is warranted to address why Black patients are more likely to have a urine culture collected but less likely to receive antibiotics.

Study Limitations

1
there is no way to ascertain whether any of the participants had symptoms indicative of an UTI.
2
there is not a reliable way to link each annual evaluation encounter with a urodynamic and/or cystoscopy procedure
3
We are also limited in our ability in ascertain whether an antibiotic was prescribed for a valid non-urinary source of infection.

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