Use and misuse of urine cultures and antibiotics in catheterised patients at a rehabilitation hospital in Malta

Abstract

Background One of the most common samples submitted to microbiology laboratories are urine specimens for culture. Objectives To assess the indications for obtaining urine cultures in a cohort of catheterised patients. The appropriateness of antimicrobial therapy in response to urine culture results was also studied. Method All catheterised inpatients at Karin Grech Rehabilitation Hospital in Malta who had urine cultures taken over a 3- month period in 2016 were included. Data included the indication for sample collection, any documented urinary symptoms, culture results, antibiotic use before and after culture result and any change in antibiotic. A departmental presentation on the appropriate care of catheterised patients was delivered and a re-audit was carried out in 2017. Results There were a total of 38 patients who were catheterised and had one or more urine cultures taken in 2016 and 55 in 2017. The commonest indications documented were fever and retention. Their indication was not documented in the medical notes in around 50% of samples taken for both years. The culture result was documented in 15% of cases in 2016 increasing to 40% in 2017. The commonest bacteria cultivated included E.Coli and Klebsiella. Empirical antibiotics were given in approximately 45% of cases who had a urine culture taken. In both 2016 and 2017, antibiotics were switched due to resistance in around 10% of all episodes when urine cultures were taken. Conclusion Lack of documentation of the indication and culture result was evident. This improved in the re-audit. A high percentage of cultures taken did not influence the clinical management. The study clearly shows inappropriate use of urine culture requests and the need to follow available guidelines.