Introduction
Urinary tract infection (UTI) is a bacterial invasion of the urothelium that causes inflammatory symptoms. Common symptoms include pain, urgency, cloudy urine, and burning sensation during urination. In clinical practice, UTI is mostly diagnosed by urine culture (referred to as urine culture), but sometimes there are misdiagnosis and unnecessary antibiotic use. To optimize the diagnosis and treatment of UTIs, a multidisciplinary panel from the United States used the RAND-modified Delphi approach to assess issues in the management of urine culture diagnosis and developed best clinical practice recommendations for the following three areas.
Survey methodology and results
A multidisciplinary panel of experts used a RAND-modified Delphi approach to identify diagnostic management best practices. Clinical issues involving urinary tract infections involving emergency department, inpatient, outpatient, and long-term care practices were divided into 3 themes. 15 experts rated the recommendations using a 9-point Likert scale, and questions that did not reach agreement were ranked and reviewed in two rounds. This resulted in 18 overarching guidance statements.
Best Practice Recommendations for Urine Cultures
NOTE: The above recommendations apply except for patients undergoing urological surgery. Unless otherwise specified, this guideline applies to all medical institutions. “Conditioned urine culture” is defined as a urine culture that is performed only after the urinalysis meets certain criteria (ie, >10 leukocytes per high-power field), despite the clinician’s request.
Best Practice Recommendations for Urine Culture Processing
Note: Unless otherwise stated, the guidelines apply to all medical facilities. Recommended for symptomatic patients only. Urine cultures should not be performed in patients without symptoms of UTI.
Urine culture report and best practice recommendations for treatment
Note: Unless otherwise stated, the guidelines apply to all medical facilities. Recommended for symptomatic patients only. Avoid unnecessary urine cultures in patients without symptoms of UTI. Due to disagreement among experts, this recommendation does not apply to patients undergoing urological surgery.
References
1. Zhang Yan, Zhou Guanghong, Wang Chuang, Xue Chunping. Analysis of the clinical diagnostic value of urine formed components and urine culture for urinary tract infection [J]. Chinese Community Physician, 2022, 38(17):67-69.
2. Kimberly CC, Barbara WT, Surbhi Le, et al. Optimal Urine Culture Diagnostic Stewardship Practice—Results from an Expert Modified-Delphi Procedure, Clinical Infectious Diseases, Volume 75, Issue 3, 1 August 2022, Pages 382–389.