De-adoption of Routine Urine Culture Testing —A Call to Action

Prescriptions for urinary tract infection (UTI) rank among the top indications for antibiotics worldwide. Although true UTI does occur frequently, overdiagnosis and overtreatment are also well-recognized problems. Because clinicians often obtain urine cultures in patients without localizing urinary symptoms, positive culture results, by definition, will reflect asymptomatic bacteriuria rather than infection. About 5% of young adults have asymptomatic bacteriuria at any time, and the prevalence is higher among patients with diabetes (10%-20%), spinal cord injury (30%), and urinary catheters (50%-70%), as well as among those living in long-term care facilities (30%-50%). In many populations, asymptomatic bacteriuria may be protective, and antibiotics can paradoxically increase the risk of developing UTI while selecting for antimicrobial resistance and increasing the risk of Clostridioides difficile infection.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research