Point-Counterpoint: Reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections.
J Clin Microbiol. 2015 Dec 9;
Authors: Humphries RM, Dien Bard J
Urinary tract infections are frequent and lead to a large number of clinical encounters. A common management strategy for patients suspected of having a urinary tract infection is to test for pyuria and bacteria by urine analysis (UA) of mid-stream urine, with initiation of antibiotic therapy and urine culture if one or both tests are positive. Although this practice was first used in the outpatient setting with mid-stream urines, some institutions allow its use in the management of catheterized patients. The ideas behind the reflex urine culture are to limit laboratory workload by not performing culture on negative specimens and to improve antimicrobial stewardship by not giving antimicrobials to patients with negative UA. The questions are, first, does reflex urine culture reduce workloads significantly and, second, does it improve antimicrobial stewardship in the era of increasing numbers of urinary tract infections due to extensively drug resistant (XDR) Gram-negative bacilli. Romney Humphries from UCLA supports the idea that reflex urine cultures are of value and describes what reflex parameters are most useful while Jennifer Dien Bard of Children's Hospital Los Angeles discusses their limitations.
PMID: 26659213 [PubMed - as supplied by publisher]