19 Aug Routine Urinalysis Tests Can Lead To Overtreating Asymptomatic Patients

MedicalResearch.com Interview with:
Jerome A. Leis, MD MSc FRCPC
Division of Infectious Diseases
Sunnybrook Health Sciences Centre
Physician Lead, Antimicrobial Stewardship Team
Faculty Quality Improvement Advisor, Centre for QuIPS
Assistant Professor, Department of Medicine
University of Toronto
Sunnybrook Health Sciences Centre
Toronto, Ontario

Medical Research: What is the background for this study? What are the main findings?

Dr. Leis: We know that urinary tract infections are frequently diagnosed among general medicine patients who lack symptoms of this infection.  We wondered whether urinalysis ordering practices in the Emergency Department influence diagnosis and treatment for urinary tract infection among these asymptomatic patients.  We found that over half of patients admitted to the general medicine service underwent a urinalysis in the Emergency Department of which over 80% lacked a clinical indication for this test.  Urinalysis results among these asymptomatic patients did influence diagnosis as patients with incidental positive results were more likely to undergo urine cultures and treatment with antibiotics for urinary tract infection.  The study suggests that unnecessary urinalysis ordering contributes to over-diagnosis and treatment of urinary tract infection among patients admitted to general medicine service.

Medical Research: What should clinicians and patients take away from your report?

Dr. Leis: A urinalysis is a useful test in excluding infection among patients who complain of symptoms of urinary tract infection, but should not be used routinely as a screening test among asymptomatic patients since positive results occur commonly and are non-specific.  In fact, over-ordering of urinalysis may be harmful to patients because positive results can introduce bias in favour of a diagnosis of urinary tract infection even when no infection is present, resulting in misdiagnosis and unnecessary antibiotics.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Leis: There is a need to develop new models of care that reduce unnecessary urine cultures and antibiotic prescriptions for urinary tract infection among asymptomatic patients.  Limiting excessive urinalysis ordering in the Emergency Department should be evaluated as a way to reduce these low-value practices among general medicine patients.

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Jerome A. Leis, MD MSc FRCPC (2015). Routine Urinalysis Tests Can Lead To Overtreating Asymptomatic Patients 

Last Updated on November 4, 2015 by Marie Benz MD FAAD