True: We order too many tests, in particular urinalyses (UA) and urine cultures. The consequences are the misdiagnosis of a catheter associated urinary tract infection (CAUTI) and the prescription of unnecessary antibiotics.
In a set of ICUs, a commitment to order UA and cultures per guidelines set forth by the American College of Critical Care Medicine/ Infectious Diseases Society of America resulted in a significant reduction in urine cultures and CAUTI rates. No harm was reported. The study can be accessed here.
We need a strategy change in CAUTI prevention. Aseptic insertion and proper maintenance are required. Daily review for ongoing need and electronic medical record prompted automatic discontinuation orders help too. Then, stop ordering unnecessary urine cultures.
Stewardship of culturing- the next challenge.
