1035New Urine Reporting Criteria to Accurately Report Nosocomial Clinical Urinary Tract Infection

Background. Reducing unnecessary antimicrobial therapy is critical to patient safety. We previously conducted an analysis to establish a colony count threshold predicting clinically significant UTI developing in hospitalized patients (AJCP 2012;137:778-84). Patients with urine culture colony counts >10 CFU/ml were 74 times more likely to have a clinically significant UTI than patients with colony counts <10 CFU/ml. With the approval of the Departments of Urology, Infectious Disease, Quality, and Infection Control we modified our urine culture laboratory reporting criteria for voided and Foley catheter samples from hospitalized patients with a length of stay of >2 days. For these patients, a positive test consists of 1-2 organisms at >10CFU/ml. Any other colony count or mixture of bacteria is reported as “Negative for Nosocomial UTI” (NNUTI). We hypothesize that this new reporting scheme would accurately report the absence of a UTI in >95% of samples. The first 5 months of the new reporting approach was validated with chart review. Methods. Inpatient urine cultures were assessed to determine if 1) a patient had been in the hospital >2 days when the culture was taken and 2) the urine was a voided or Foley sample. The culture report was assessed with chart review by a single Infectious Disease Physician to determine if the patient had signs and symptoms of a UTI when NNUTI was the result. Parameters to determine UTI included fever >100.4°F, frequency, dysuria, or flank pain, and change in clinical status with no other reason other than UTI. A negative urinalysis and no therapy supported the NNUTI diagnosis. Results. In 5 months, 29226 urine samples were evaluated. 401 patients were reported as NNUTI. Of these, only 5 (1.2%) patients met criteria for potential symptomatic UTI. Two patients treated for asymptomatic UTI were subsequently diagnosed with Clostridium difficile infection and renal failure, respectively. The second patient died of an adverse reaction to antibiotic therapy. No patient was adversely impacted by a NNUTI culture report. Conclusion. The new reporting criteria accurately reported the absence of a UTI in >98% of samples that had bacterial counts of <10 CFU/ml. Overtreatment of UTI has serious clinical consequences. Disclosures. All authors: No reported disclosures.