Decreasing urine culture rates in hospitalized internal medicine patients

Background: There are no previous studies on decreasing urine cultures in hospitalized internal medicine patients by a combination of physician education and reflex cancellation of urine cultures in those with a negative dipstick urinalysis. Methods: We compared urine culture rates in all hospitalized internal medicine patients 18 years or older before intervening (2016), during medical education efforts (2017), and after reflex cancellation of urine cultures in patients with a negative dipstick (negative leukocyte esterase and nitrites) (2018, 2019). Results: Compared to the preintervention period (2016), urine cultures decreased from a baseline of 32.7% (95% confidence intervals [95%CI]—31.7-33.6) to 26.6% (95%CI—25.8%-27.4%) after medical education efforts, and to 18.2% (95%CI—17.4%-19.0%) and to 15.2 (95%CI—14.5%-15.9%) during the 2 years after reflex cancellation of the urine cultures. There were no physician complaints and there were no urine cultures orders after reflex cancellation. Conclusions: We conclude that physician education and cancellation of urine cultures in those with negative dipsticks resulted in a persistent decrease in urine cultures of around 50%. Extrapolation to other settings requires caution since the results are dependent on patient selection, physician behavior, and methods of urine testing.