Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department
Dublin Core
Title
Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department
Subject
Urinalysis, Urinary tract infection, Urine culture, Urinalysis reflex
Description
Abstract
Background Clinical criteria are essential for diagnosing urinary tract infections (UTIs) followed by urine testing,
including urinalysis (UA). No study has evaluated the potential related factors that may guide the appropriate
collection of urine cultures. Therefore, we aimed to assess the factors that may guide the appropriate collection of
urine cultures.
Methods This was a case-control study of patients for whom a urine culture and a UA were ordered in the
emergency department (ED) between February 2018 and December 2022. The cases included patients with positive
cultures, whereas the controls included patients without growth. Patients were excluded if they were pregnant,
underwent any urological procedure, received antibiotics within 3 days before ED presentation, or before culture
collection.
Results Of the 263 patients, 123 had growth and 140 did not have growth in urine cultures. In the univariate analysis,
female gender, urinary symptoms, urinary white blood cell (WBC) count>5 cells/hpf, and nitrite in urine were
significantly associated with growth (P<0.05). However, only female gender (aOR, 1.86; 95% CI, 1.06–3.24), urinary
WBC count>5 cells/hpf (aOR, 4.60; 95% CI, 2.21–9.59), and positive nitrite in urine (aOR, 21.90; 95% CI, 2.80–171.00)
remained significant in the multivariable analysis. These factors also remained significant in the subgroup of patients
with urinary symptoms, except for the female gender.
Conclusion A high urinary WBC count and positive nitrite in UA should be utilized as a guide to collect urine culture,
particularly in female patients, to limit the unnecessary ordering of urine culture in the ED. These factors can be used
as evidence-based UA reflex criteria as an antimicrobial stewardship intervention.
Keywords Urinalysis, Urinary tract infection, Urine culture, Urinalysis reflex
Background Clinical criteria are essential for diagnosing urinary tract infections (UTIs) followed by urine testing,
including urinalysis (UA). No study has evaluated the potential related factors that may guide the appropriate
collection of urine cultures. Therefore, we aimed to assess the factors that may guide the appropriate collection of
urine cultures.
Methods This was a case-control study of patients for whom a urine culture and a UA were ordered in the
emergency department (ED) between February 2018 and December 2022. The cases included patients with positive
cultures, whereas the controls included patients without growth. Patients were excluded if they were pregnant,
underwent any urological procedure, received antibiotics within 3 days before ED presentation, or before culture
collection.
Results Of the 263 patients, 123 had growth and 140 did not have growth in urine cultures. In the univariate analysis,
female gender, urinary symptoms, urinary white blood cell (WBC) count>5 cells/hpf, and nitrite in urine were
significantly associated with growth (P<0.05). However, only female gender (aOR, 1.86; 95% CI, 1.06–3.24), urinary
WBC count>5 cells/hpf (aOR, 4.60; 95% CI, 2.21–9.59), and positive nitrite in urine (aOR, 21.90; 95% CI, 2.80–171.00)
remained significant in the multivariable analysis. These factors also remained significant in the subgroup of patients
with urinary symptoms, except for the female gender.
Conclusion A high urinary WBC count and positive nitrite in UA should be utilized as a guide to collect urine culture,
particularly in female patients, to limit the unnecessary ordering of urine culture in the ED. These factors can be used
as evidence-based UA reflex criteria as an antimicrobial stewardship intervention.
Keywords Urinalysis, Urinary tract infection, Urine culture, Urinalysis reflex
Creator
Nada M. Alateeq1
, Manal B. Mohammed1
, Albandari T. Alsubaie1
, Amal A. Alshehri1
, Dalya Attallah2
, Salem Agabawi3
and Abrar K. Thabit1*
, Manal B. Mohammed1
, Albandari T. Alsubaie1
, Amal A. Alshehri1
, Dalya Attallah2
, Salem Agabawi3
and Abrar K. Thabit1*
Source
https://doi.org/10.1186/s12245-024-00656-8
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Nada M. Alateeq1
, Manal B. Mohammed1
, Albandari T. Alsubaie1
, Amal A. Alshehri1
, Dalya Attallah2
, Salem Agabawi3
and Abrar K. Thabit1*, “Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12371.