Urine Cultures in Hospitalized Geriatric Patients Presenting With Fever

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• 作者：Zvi Shimoni ; MD^⁎ ; ^&dagger ; ; Ruslan Avdiaev ; MD^⁎ ; Paul Froom ; MD^&Dagger ; ; ^§ ; ; ^{froomp@gmail.com}
• 关键词：Urine culture ; Geriatric patients ; Fever ; Clinical usage
• 刊名：The American Journal of the Medical Sciences
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：353
• 期：1
• 页码：17-21
• 全文大小：212 K
• 卷排序：353

文摘

Urine cultures are commonly ordered in geriatric patients presenting with fever in the emergency department, but it is unclear if indiscriminate urine culture testing is warranted.Materials and MethodsWe selected 708 consecutive geriatric patients with a chief complaint of fever to determine the clinical usage (changes in antibiotic therapy according to culture results) and the costs of culturing the urine that included the need for catheterization to obtain a sample for culture and complications from catheterization. We divided the patients into those with and without an extraurinary tract source for fever on admission.ResultsUrine cultures were performed in 74.9% (233/312) of the patients with a source for the fever outside the urinary tract and required urinary catheterization to obtain a sample in 36.8% (95/233) of those patients. Cultures were positive for bacteria 29.6% of the time (69/233), but did not result in the change of antibiotic treatment in any of the patients. Urine cultures were performed in 92.6% (326/352) of the patients without an extraurinary tract source for the fever, required catheterization in 49.7% (162/326) of the patients and 58.3% (190/326) of the cultures were positive for bacteria. Urine culture sensitivities changed antibiotic therapy in 24.2% (46/190) of the patients. There were no patients in either group with complications from urinary catheterization, but indwelling catheter rates increased inappropriately in both the groups.ConclusionsWe conclude that urine culture testing is unnecessary in hospitalized geriatric patients who on admission have an extraurinary tract source for their fever, but it has clinical usage when the source for the fever on admission is unclear.