In the August 17th edition of the WAVE, I wrote about the need to change our paradigm for diagnosing UTIs. Subsequently, articles in this month’s Caring for the Ages (Antibiotic Stewardship) and JAMA Internal Medicine (Urinalysis orders for ER admits) suggest we should be more resistant to ordering screening UAs just to be sure the patient doesn’t have a UTI as a possible cause of their change of condition.

In both articles, the ordering of a UA appeared to introduce cognitive bias for prescribing antibiotics for asymptomatic bacteriuria, even when criteria for the diagnosis of a clinically significant UTI were absent.  As the JAMA article title suggests, this may be another example where high value care is more a matter of saying “No” to the traditional urge to order a UA.  As a clinician, this is a real culture change where families, nurses, and ERs seem to constantly focus on the undiagnosed UTI as the primary cause for a patient’s decline.  The literature no longer supports this approach.  Like Dr. Brubaker in the Caring for the Ages article, we need to actively discourage the ordering of unnecessary UAs.

At CALTCM, we have recently announced the Best Practice Implementation Awards Project for our 2016 annual meeting.  I believe Antibiotic Stewardship in the care of UTI’s is a project worth developing.

Caring for the Ages article

JAMA Article

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