Avoiding unnecessary urine cultures and treatment

Urine samples are often submitted seemingly without a clear clinical justification. As bacteriuria is a common finding in the elderly, diabetic patients and patients with longterm indwelling or suprapubic catheters, a lab report with a positive culture might then prompt unnecessary antibiotic treatment.  The following guide might assist:

  • screening for bacteriuria is only indicated for first trimester antenatal and certain preoperative patients
  • avoid sampling urine from patients who do not have symptoms of urinary infection, regardless of urinalysis and/or appearance/smell of the urine
  •  patients with UTI who have responded to treatment do NOT require repeat cultures to demonstrate clearance
  • avoid treating asymptomatic bacteriuria in patients with diabetes, older persons, patients with or without indwelling catheters, or patients with spinal cord injuries. Treatment does not improve outcomes and drives antimicrobial resistance. Presence of profuse white cells or abnormal urinalysis in such patients is NOT specific for infection.

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