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September 24, 2019

De-adoption of Routine Urine Culture Testing—A Call to Action

Author Affiliations
  • 1Divisions of Infectious Diseases and General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 2Centre for Quality Improvement and Patient Safety and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 4Division of General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada
JAMA Intern Med. 2019;179(11):1466-1468. doi:10.1001/jamainternmed.2019.4515

Prescriptions for urinary tract infection (UTI) rank among the top indications for antibiotics worldwide.1,2 Although true UTI does occur frequently, overdiagnosis and overtreatment are also well-recognized problems. Because clinicians often obtain urine cultures in patients without localizing urinary symptoms, positive culture results, by definition, will reflect asymptomatic bacteriuria rather than infection. About 5% of young adults have asymptomatic bacteriuria at any time, and the prevalence is higher among patients with diabetes (10%-20%), spinal cord injury (30%), and urinary catheters (50%-70%), as well as among those living in long-term care facilities (30%-50%).3-7 In many populations, asymptomatic bacteriuria may be protective, and antibiotics can paradoxically increase the risk of developing UTI while selecting for antimicrobial resistance and increasing the risk of Clostridioides difficile infection.

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