Infectious Disease

“Insignificant” urine culture results cause clinicians to seek solutions

April 20, 2021

1 min read

Source / information

Source:
Hansen M. et al. Optimizing urine collection is an important way to manage it in primary care. Presented at: Society for Healthcare Epidemiology of America Spring Meeting; 13-16 April 2021 (virtual meeting).

Disclosure:
Grigoryan reports having received grants from several federal agencies. Healio Primary Care was unable to confirm the other researchers’ relevant financial statements at the time of publication.

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More than half of the urine cultures collected at two primary care clinics in the past 16 months were contaminated. This is evident from data presented during the Spring Meeting of the Virtual Society for Health Care Epidemiology in America.

Urine cultures are according to “the most common microbiological tests in the outpatient sector” Michael Allen Hansen, MD, MPH, MS, an assistant professor at Baylor College of Medicine and colleagues. However, most studies of urine collection have focused on the process in ED or in the inpatient setting.

Reference: Hansen M. et al. Optimizing urine collection is an important way to manage it in primary care.

Therefore, they analyzed urine cultures from 1,265 adults (mean age 43.2 years; 84% women; 68.1% born outside of the US) collected at two publicly funded primary care clinics in Houston from November 2018 to March 2020. The most common comorbidities in the patients were obesity (34.1%), high blood pressure (26%) and diabetes (20.4%).

According to the researchers, 55% of the urine cultures were contaminated, 24% were positive for uropathogens, and the remaining 21% showed no growth.

Senior author studying Larissa Grigoryan, MD, PhD, An assistant professor in the Department of Family and Community Medicine at Baylor College of Medicine told Healio Primary Care that the contamination rate was the highest she has ever seen.

Larissa Grigoryan

“Studies have shown that some clinics have contamination rates as low as 1% and others as low as 42%,” she said. “In our study … more than half of the urine cultures had meaningless results.”

According to Grigoryan, one reason for so many contaminated cultures could be “the high number of obese patients who are physically difficult to perform the midstream clean-catch urine collection technique.”

Other possible reasons include poor health literacy and understanding of English in the study cohort, as well as the reluctance of health professionals to provide a detailed description of urine collection, Grigoryan continued.

She said she was applying for a scholarship to develop an intervention, perhaps one with picture or video instructions, that would lower decontamination rates.

“A 1% contamination rate might not be realistic, but I hope the rate is lower, much lower than what we have now,” Grigoryan said.

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