235 - Diagnostic Accuracy of Clean Catch Urine Cultures Analyzed by Language Spoken

The financial and time constraints of follow-up mean most of these children continue empiric therapy without definitive diagnosis. In the long-term, we aim to identify an upstream intervention would be cost-effective in improving accurate diagnosis and decreasing unnecessary antibiotic use.   

In our data set, 43% of families spoke a primary language other than English. Given the need for clean catch instructions, we stratified patients based on language while looking at rates of diagnostic clean catch urine culture results.   


Design/Methods: We conducted a retrospective chart review analysis of 115 patients from July 2021 to October 2022 with a diagnosis of UTI who presented to the emergency room at our urban, free-standing, academically-affiliated children’s hospital. We defined cultures as diagnostic when they resulted no growth or >100,000 cfu of a single pathogen. Baseline categorical data were compared using chi-squared test, as appropriate. 

Results: We found that 83.1% of English-speaking, 75.6% of Spanish-speaking and 77.8% of non-English and non-Spanish speaking patients had non-diagnostic clean catch urine cultures. The chi-squared analysis did not show a statistical significance between these groups. 

Conclusion(s): Recent national antimicrobial stewardship efforts have focused on narrow antibiotic choice and decreased duration of therapy. Inherent in this work is improving the diagnostic accuracy of lab tests that lead to antibiotics. Our team hypothesized that families’ primary language would impact the ability to obtain diagnostic samples. However, our data suggest that poor diagnostic accuracy is not attributable to language alone. Future analysis and intervention work should include concepts of health literacy in addition to language access. Interventions must also consider efficiency and feasibility in busy ED environments.