Concordance between Infectious Disease Society of America Criteria for Urinary Tract Infection Testing and Treating Vs. Emergency Department Actual Practice

IntroductionSymptomatic and asymptomatic urinary tract infections (UTIs) are common. The Infectious Disease Society of America (IDSA) discourages testing and treating ASB other than in pregnant women during routine obstetric visit screening and patients undergoing urologic procedures with expected mucosal bleeding. Unnecessary urinalysis (UA) and inappropriate antibiotic use persist in Emergency Departments (EDs). This study aims to evaluate UA testing and antibiotic treatment patterns for ASB in an urban ED, assessing adherence to IDSA guidelines and setting baseline rates for an educational intervention to align testing and treatment with IDSA guidelines. MethodsWe conducted a 15-month study to assess adherence to IDSA guidelines for proper UTI screenings and prescribing. We reviewed records of 50 adult patients who had a UA at the Long Island Jewish Medical Center ED to determine whether they met IDSA criteria for UA testing and appropriate antibiotic use. Patients with sepsis or other conditions requiring empiric antibiotics were excluded. We performed a univariate analysis to describe the population and factors associated with treating urinalysis findings. Statistical significance was set at p <0.05. ResultsSixty-four percent of patients were asymptomatic and 36% were symptomatic. None of the asymptomatic patients met IDSA criteria for UA testing. Symptomatic patients were nearly-statistically more likely than asymptomatic patients to have a positive UA (72.2% vs. 43.8%, p = 0.06), and were more-often prescribed antibiotics for a positive UA (61.5% vs. 14.3%; p = 0.0128). They were also more-often prescribed antibiotics for a negative UA (20.0% vs. 0%; p = 0.05). DiscussionThe study findings revealed significant discordance between IDSA guidelines and current ED practices, with 64% of UA tests deemed unnecessary for ASB patients. These results align with previous studies highlighting the prevalence of over-testing with UAs and over-treatment of ASB. Unnecessary testing and inappropriate antibiotic treatment lead to increased costs and risks of antibiotic resistance, adverse drug events, and Clostridium difficile infection. This study highlights the necessity for planned educational initiatives to reduce unnecessary UAs and treatment and improve adherence to evidence-based guidelines.