Journal Article10.1017/ICE.2018.278
Impact of tiered interventions to decrease routine urine cultures in asymptomatic patients undergoing arthroplasty
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TL;DR: The purpose of this project was to evaluate the impact of education alone followed by the removal of urine culture from the preoperative order set on screening and treatment of ASB prior to elective hip and knee joint arthroplasty.
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Abstract: Prosthetic joint infection (PJI) is a challenging complication after joint arthroplasty. Our institution performed preoperative screening and treatment of asymptomatic bacteriuria (ASB) prior to joint replacements. This is a common practice despite a lack of evidence showing benefit or a decrease in postoperative PJI. This practice can lead to increased rates of Clostridioides (Clostridium) difficile infection, multidrug-resistant organisms, higher costs, and adverse reactions. Furthermore, in patients who have both ASB and PJI, studies show that the causative organisms are usually discordant. In April 2016, the antimicrobial stewardship team (AST) met with the orthopedic surgery department to provide education and recommended removing routine urine culture from preoperative order sets for joint arthroplasty. The purpose of this project was to evaluate the impact of education alone followed by the removal of urine culture from the preoperative order set on screening and treatment of ASB prior to elective hip and knee joint arthroplasty.
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Citations
Knowledge and Practices of Physicians and Nurses Related to Urine Cultures in Catheterized Patients: An Assessment of Adherence to IDSA Guidelines.
Sonali D Advani,Catherine A. Gao,Rupak Datta,Lawrence Sann,Cindy Smith,Michael S. Leapman,Adam B. Hittelman,James R. Sabetta,Louise-Marie Dembry,Richard A. Martinello,Manisha Juthani-Mehta +10 more
TL;DR: The practice of pan-culturing and inappropriate urine culture orders may contribute to overdiagnosis of surveillance CAUTIs, delay in diagnosis of alternative infections, and excess CDIs.
Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges.
TL;DR: In this paper, the authors highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interventions to improve urine culture practices in the acute care setting.
References
Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults
Lindsay E. Nicolle,Suzanne F. Bradley,Richard Colgan,James C. Rice,Anthony J. Schaeffer,Thomas M. Hooton +5 more
TL;DR: Pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy and they should be treated if the results are positive, and the duration of antimicrobial therapy should be limited.
Diagnosis and treatment of uncomplicated urinary tract infection
Thomas M. Hooton,Walter E. Stamm +1 more
TL;DR: The optimal treatment duration for acute uncomplicated pyelonephritis has not been established, but 10- to 14-day regimens are recommended, and patients prefer to use antimicrobials that attain high renal tissue levels, such as a fluoroquinolone, trimethoprim-sulfamethoxazole, or an aminoglycoside for pyel onephritis.
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Elimination of Screening Urine Cultures Prior to Elective Joint Arthroplasty.
Michael J. Lamb,Laura Baillie,Dariusz Pajak,Jan Flynn,Vikas Bansal,Andrew E. Simor,Mary Vearncombe,Sandra A N Walker,Susan Clark,Jeffrey Gollish,Jerome A. Leis,Jerome A. Leis +11 more
TL;DR: Discontinuing routine processing of screening urine cultures prior to elective joint arthroplasty resulted in substantial reduction in urine cultures ordered and antimicrobial prescriptions for asymptomatic bacteriuria, without any significant impact on incidence of prosthetic joint infection.
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Editorial Commentary: Prosthetic Joint Replacement: Should Orthopedists Check Urine Because It's There?
TL;DR: Preoperative screening with urinalysis and/or urine culture has been advocated to prevent ASB from causing PJI, and early evidence that ASB is a marker of risk, rather than a risk factor itself is found.
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Education alone is not enough in ventilator associated pneumonia care bundle compliance.
Hadi Hamishehkar,Mahdi Vahidinezhad,Simin Ozar Mashayekhi,Parina Asgharian,Hadi Hassankhani,Ata Mahmoodpoor +5 more
TL;DR: Education seems to be ineffective on improving VAP care bundle compliance, and frequent recall of the necessity of the V AP care bundle and the continuous supervision of ICU staffs is highly recommended.