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Impact of routine urine cultures on antibiotic usage in those undergoing a routine annual spinal cord injury evaluation

Spinal Cord volumeĀ 61,Ā pages 684ā€“689 (2023)Cite this article

Subjects

Abstract

Objective

The Veterans Health Administration (VHA), the largest single provider of spinal cord injury and disorder (SCI/D) care in the United States, currently mandates that every patient receives a screening urine culture during the annual evaluation, a yearly comprehensive history and physical examination. This testing has shown in a small subset of patients to overidentify asymptomatic bacteriuria that is then inappropriately treated with antibiotics. The objective of the current analysis was to assess the association of the annual evaluation on urine testing and antibiotic treatment in a national sample of Veterans with SCI/D.

Design/Method

A retrospective cohort study using national VHA electronic health record data of Veterans with SCI/D seen between October 1, 2017-September 30, 2019 for their annual evaluation.

Results

There were 9447 Veterans with SCI/D who received an annual evaluation; 5088 (54%) had a urine culture obtained. 2910 cultures (57%) were positive; E. coli was the most common organism obtained (12.9% of total urine cultures). Of the patients with positive urine cultures, 386 were prescribed antibiotics within the 7 days after that encounter (13%); of the patients with negative cultures (nā€‰=ā€‰2178), 121 (6%) were prescribed antibiotics; thus, a positive urine culture was a significant driver of antibiotic use (pā€‰<ā€‰0.001).

Conclusion

The urine cultures ordered at the annual exam are often followed by antibiotics; this practice may be an important target for antibiotic stewardship programs in SCI.

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Fig. 1: Urine cultures obtained during SCI/D annual evaluation in fiscal years 2018 and 2019.
Fig. 2: Urine culture microbiology and related antibiotic use.

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Data availability

The data that supports the findings of this study are available from the Veterans Health Administration but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Veterans Health Administration.

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Authors and Affiliations

  1. Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Sarah MayĀ &Ā Barbara W. Trautner

  2. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Annette Walder,Ā Casey Hines-Munson,Ā Barbara W. TrautnerĀ &Ā Felicia Skelton

  3. Department of Pharmacy Practice, Texas Southern University, Houston, TX, USA

    Ivy Poon

  4. H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA

    S. Ann HolmesĀ &Ā Felicia Skelton

  5. Center for Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Chicago, IL, USA

    Charlesnika T. Evans

  6. Northwestern University, Department of Preventive Medicine and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Chicago, IL, USA

    Charlesnika T. Evans

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  1. Sarah May
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Contributions

SM was responsible for the overall writing of the manuscript, and FS was responsible for overseeing all aspects of the manuscript. All other authors contributed equally to study design, data collection and editing/revision of final manuscript.

Corresponding author

Correspondence to Felicia Skelton.

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The authors declare no competing interests.

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May, S., Walder, A., Hines-Munson, C. et al. Impact of routine urine cultures on antibiotic usage in those undergoing a routine annual spinal cord injury evaluation. Spinal Cord 61, 684ā€“689 (2023). https://doi.org/10.1038/s41393-023-00938-7

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  • DOI: https://doi.org/10.1038/s41393-023-00938-7

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