116 - Management of Positive Urine Cultures Collected via Bag Specimen with Mislabeled Method of Collection

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 116
Publication Number: 116.114

Danni Liang, Stanford University School of Medicine, Palo Alto, CA, United States; Alan Schroeder, Stanford University School of Medicine, Palo Alto, CA, United States; Lydia Maleknia, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Jessica M. Allan, Palo Alto Medical Foundation/ Stanford Children's Hospital, Palo Alto, CA, United States; Miranda Kane, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Veena Goel. Jones, Stanford University School of Medicine, Palo Alto, CA, United States; Ritu Patel, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Tom Newman, UCSF, SAN CARLOS, CA, United States; Kenneth B. Roberts, University of North Carolina at Chapel Hill, Mebane, NC, United States; Marie Wang, Stanford University School of Medicine, Sunnyvale, CA, United States

Presenting Author(s)

Danni Liang, MD (she/her/hers)

Pediatric Hospital Medicine Fellow
Stanford University School of Medicine
Palo Alto, California, United States

Background:

We recently conducted a multicenter study of children with positive urine cultures (UCx) without pyuria in which we excluded 60% of children meeting inclusion criteria because their UCx were actually obtained as bag specimens but mislabeled as catheterized (CATH) or clean catch (CC) specimens in the electronic health record (EHR) microbiology report. It is unclear how often positive UCx from bag specimens are treated with antibiotics and how a mislabeled source of collection affects management decisions.

Objective:

1) To determine the rate of antibiotic treatment for children with positive UCx without pyuria whose bag UCx were mislabeled as CATH/CC, 2) To compare the treatment rate of patients with documentation of bag UCx in follow-up management notes to those without this documentation.

Design/Methods:

We conducted a multicenter retrospective cohort study of a subset of children excluded from the aforementioned investigation due to a mislabeled method of urine collection. This cohort included 372 symptomatic children age 1-24 months in 3 healthcare systems from 2011-2020 with a positive UCx (≥50,000 CFU/mL of a uropathogen) without pyuria (≥5 WBC/hpf and/or positive leukocyte esterase) not given antibiotics at presentation. We randomly selected 82 of the 372 eligible children with a mislabeled method of urine collection (i.e., EHR classification as CATH/CC but found to have bag specimens on chart review). Follow-up management notes recording treatment decisions related to positive UCx results were assessed for documentation of the urine collection method. The primary outcome was antibiotic treatment within 7 days.

Results:

Of the 82 included children, 38% were female and median age was 11 months. In the EHR, 79 (96%) were labeled as CC and 3 (4%) as CATH. Bag cultures were most commonly obtained due to 1) unsuccessful CATH/CC (13%), 2) parental request (26%), or 3) no specified reason (55%). Twenty-three (27%) children were treated with antibiotics. Antibiotic treatment was given to 6/62 (13%) children with documentation of bag UCx in follow-up management notes, compared to 14/20 (70%) children who either had no documentation of urine collection method or documentation that the collection method was unclear (p< 0.001).

Conclusion(s):

In a cohort of children who had bag UCx mislabeled as CATH/CC specimens, 27% received antibiotics and treatment rates were lower in patients with documentation of bag UCx in follow-up management notes. Mislabeling of urine collection methods within the EHR may contribute to overtreatment. These findings may inform efforts to improve appropriate treatment of positive UCx.