Implementation of conditional reflex urine culturing decreases unnecessary antimicrobial use Article Swipe
Aoi Yogo
,
Elie Saade
,
Eric M. Ransom
,
Brigid Wilson
,
Timothy C Jenkins
,
Abhishek Deshpande
,
Curtis J. Donskey
,
Zainab Albar
,
Lauren Epstein
,
Leila S Hojat
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1017/ice.2025.10309
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1017/ice.2025.10309
Objective: To evaluate the impact of implementation of a conditional reflex urine culturing strategy on urine culture rates, antimicrobial use, and clinical outcomes in hospitalized adults. Design: Pre-post quasi-experimental study. Setting: Emergency departments and inpatient units within a large, integrated healthcare system in Northeast Ohio, comprising 10 medical centers. Patients: Adult patients with a urine culture ordered from June 1, 2018, to May 31, 2023. Methods: A system-wide intervention was implemented on June 1, 2020, requiring urinalysis (UA) with pyuria findings to trigger a urine culture order. We compared urine culture rates, antimicrobial use (measured by days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC]), and clinical outcomes between pre-and post-intervention periods. Results: The intervention resulted in an 85.4% reduction in urine culture rates (0.54 vs 3.71 per 100 patient days). Antimicrobial use decreased, with DOT per 100 patient days dropping by 11.5% and DASC/DOT by 16.1%. No significant differences were observed in Clostridioides difficile infection rate, subsequent bloodstream infections with urinary pathogens, or mortality between pre- and post-intervention groups. Conclusions: A conditional reflex urine culturing strategy implemented as part of a diagnostic stewardship framework reduced urine culture and antimicrobial use without adverse clinical outcomes. This highlights the potential of diagnostic stewardship to optimize antimicrobial use in hospitalized adults.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1017/ice.2025.10309
- https://www.cambridge.org/core/services/aop-cambridge-core/content/view/E2A5810B85371DEF6AC13AB45E3A25E4/S0899823X25103097a.pdf/div-class-title-implementation-of-conditional-reflex-urine-culturing-decreases-unnecessary-antimicrobial-use-div.pdf
- OA Status
- hybrid
- Cited By
- 1
- References
- 19
- OpenAlex ID
- https://openalex.org/W4415022526
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https://openalex.org/W4415022526Canonical identifier for this work in OpenAlex
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https://doi.org/10.1017/ice.2025.10309Digital Object Identifier
- Title
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Implementation of conditional reflex urine culturing decreases unnecessary antimicrobial useWork title
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-10-10Full publication date if available
- Authors
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Aoi Yogo, Elie Saade, Eric M. Ransom, Brigid Wilson, Timothy C Jenkins, Abhishek Deshpande, Curtis J. Donskey, Zainab Albar, Lauren Epstein, Leila S HojatList of authors in order
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https://doi.org/10.1017/ice.2025.10309Publisher landing page
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https://www.cambridge.org/core/services/aop-cambridge-core/content/view/E2A5810B85371DEF6AC13AB45E3A25E4/S0899823X25103097a.pdf/div-class-title-implementation-of-conditional-reflex-urine-culturing-decreases-unnecessary-antimicrobial-use-div.pdfDirect link to full text PDF
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hybridOpen access status per OpenAlex
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https://www.cambridge.org/core/services/aop-cambridge-core/content/view/E2A5810B85371DEF6AC13AB45E3A25E4/S0899823X25103097a.pdf/div-class-title-implementation-of-conditional-reflex-urine-culturing-decreases-unnecessary-antimicrobial-use-div.pdfDirect OA link when available
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