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Impact of two-step urine culture ordering in the emergency department: a time series analysis
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  • Published on:
    Inappropriate antibiotic prescription for asymptomatic bacteriuria
    • Emily T O'Neill, Pharm.D. Candidate The University of Florida College of Pharmacy
    • Other Contributors:
      • Lindsey A Little, Pharm.D. Candidate
      • Denise Kelley, Pharm.D., BCPS, AAHIVP
      • Christopher A Jankowski, Pharm.D., BCPS

    We read with great interest the original research done by Stagg et al where rates of unnecessary antibiotic use for asymptomatic bacteriuria (ASB) were decreased by implementing a two-step urine culture algorithm in the emergency department (ED). [1] We want to congratulate the authors for their successful research, and hope that algorithms such as the two-step ordering process will be implemented as widespread protocol to help decrease the overutilization of antibiotics for ASB.

    We have presented the findings of our own retrospective observational IRB-approved study performed at a 695-bed academic medical center to discern the downstream impact of routine urinalysis and urine cultures ordered from the ED on antibiotic prescribing. We hope these results will add to the growing body of evidence for stricter protocol regarding urine testing and subsequent treatment. The primary objective of our study was to evaluate the incidence of antibiotic treatment based on urinalysis and urine culture results with or without associated urinary symptoms. Secondary objectives included: incidence of symptoms documented in the medical record for patients who were ordered a urinalysis with or without urine culture, incidence of antibiotic treatment of ASB, and quantification of mean antibiotic dose given to patients with clinically defined ASB.

    Adult patients who had urinalysis with or without a urine culture performed in the ED were identified and randomized by reports genera...

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    Conflict of Interest:
    None declared.