Urine Culture Stewardship in Patients without Indwelling Urinary Catheters

Who is At Risk

The prevalence of asymptomatic bacteriuria (ASB) in patients without indwelling urinary catheters varies widely among groups and is more common in women, the elderly, those with urogenital abnormalities, institutionalized patients, and certain comorbidities. Treatment of ASB in these patients contributes significantly to antibiotic misuse.

Use of Urine Cultures in Patients without Indwelling Urinary Catheters

Here are some examples of appropriate and inappropriate uses of urine cultures that you can consider when drafting your list of facility-approved indications, other indications might exist at your facility:

These examples are not meant to replace the clinical judgement of an individual treating provider. Decisions regarding patient diagnosis and management depend on individual patient characteristics and medical history. For example, conditions other than a bacterial urinary tract infection (UTI) may cause symptoms or pyuria; additional investigation for nonbacterial causes of pyuria, including but not limited to sexually transmitted diseases, tuberculosis, interstitial cystitis, and carcinoma in situ of the bladder, may be warranted.

Appropriate Uses

Urine cultures may not be needed in cases of uncomplicated cystitis unless patient fails empiric treatment.

  • Dysuria, urgent or frequent urination, suprapubic pain or tenderness, flank pain or costovertebral angle tenderness, acute hematuria, or pelvic discomfort
  • New onset or worsening sepsis with no identifiable cause
  • Fever or altered mental status without evidence of another source on history, physical examination, or laboratory testing
  • Screening for asymptomatic bacteriuria (ASB)
    • Early pregnancy
    • Prior to certain urology procedures
  • Preoperative evaluations, prior to urologic surgeries where mucosal bleeding is anticipated
  • In spinal cord injury patients: increased spasticity, autonomic dysreflexia, sense of unease
Inappropriate Uses
  • Odorous, cloudy, or discolored urine in the absence of other localizing signs/symptoms
  • Reflex urine cultures based on urinalysis results, such as pyuria, in the absence of other indications
  • Urine culture to document response to therapy unless symptoms fail to resolve
  • Screening for ASB in most groups
  • Preoperative evaluations in most groups