Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure
Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure
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DOI：
10.1093/cid/ciab987
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发表时间：
2022-04-22
影响因子：
11.8
通讯作者：
Morgan, Daniel J.
中科院分区：
文献类型：
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作者：
Claeys, Kimberly C.;Trautner, Barbara W.;Morgan, Daniel J.
尿培养是非特异性的，经常导致尿路感染的误诊和不必要的抗生素。诊断管理是一套程序，修改测试顺序，处理和报告，以优化诊断和下游治疗。在这项研究中，我们旨在为尿液培养诊断管理的最佳实践提供专家指导。方法采用rand修正的德尔菲法和多学科专家小组确定诊断管理的最佳做法。临床问题，以指导建议分为三个主题领域（订购，处理，报告）在实践设置急诊科，住院，门诊和长期护理。15位专家按照9分的李克特量表对建议进行排名。专家组在虚拟会议上讨论了未达成一致的建议，然后通过电子邮件完成了第二轮排名。经过对结果的二次审查和小组讨论，制定了一系列指导声明。结果共审查了165个问题。专家组就104项达成了一致意见，包括18项总体指导声明。建议采用以下策略来优化尿培养的订购：要求记录症状，在没有症状的情况下发送警报以阻止订购，并取消重复培养。对于尿培养处理，条件尿培养和尿白细胞计数作为标准支持。对于尿培养报告，适当的做法包括在特定条件下推动不鼓励治疗和选择性报告抗生素以指导治疗决策。结论这18条指导声明可以优化尿培养的使用，以获得更好的患者预后。在这项研究中，我们旨在为尿液培养诊断管理的最佳实践提供专家指导。这18项指导可以优化不完美尿液培养的使用，以获得更好的患者预后。
Background Urine cultures are nonspecific and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. In this study, we aimed to develop expert guidance on best practices for urine culture diagnostic stewardship. Methods A RAND-modified Delphi approach with a multidisciplinary expert panel was used to ascertain diagnostic stewardship best practices. Clinical questions to guide recommendations were grouped into three thematic areas (ordering, processing, reporting) in practice settings of emergency department, inpatient, ambulatory, and long-term care. Fifteen experts ranked recommendations on a 9-point Likert scale. Recommendations on which the panel did not reach agreement were discussed during a virtual meeting, then a second round of ranking by email was completed. After secondary review of results and panel discussion, a series of guidance statements was developed. Results One hundred and sixty-five questions were reviewed. The panel reaching agreement on 104, leading to 18 overarching guidance statements. The following strategies were recommended to optimize ordering urine cultures: requiring documentation of symptoms, sending alerts to discourage ordering in the absence of symptoms, and cancelling repeat cultures. For urine culture processing, conditional urine cultures and urine white blood cell count as criteria were supported. For urine culture reporting, appropriate practices included nudges to discourage treatment under specific conditions and selective reporting of antibiotics to guide therapy decisions. Conclusions These 18 guidance statements can optimize use of urine cultures for better patient outcomes.In this study, we aimed to develop expert guidance on best practices for urine culture diagnostic stewardship. These 18 guidancestatements can optimize use of the imperfect urine culture for better patient outcomes.