Urinalysis Overuse Leads to Unnecessary Antibiotics

Urinalysis is often overused in asymptomatic elderly patients, resulting in unnecessary urine cultures and antibiotics, according to a recent study.

While urinalysis is highly effective at ruling out urinary tract infections (UTI), positive results are of little help, as they occur in nearly 90% of asymptomatic elderly patients.
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In order to further examine the effects of the possible overuse of urinalysis among elderly patients in emergency departments, researchers conducted a prospective cohort study of 403 patients (mean age 79 years) assessed 24 hours after admission to the emergency department for symptoms indicating the need for urinalysis.

Overall, 250 (62%) underwent urinalysis upon admission, of which 211 lacked any symptoms of UTI and 198 (79.2) lacked UTI and kidney injury.

Positive urinalysis results were associated with the probability of unnecessary urine cultures and antibiotic prescriptions in asymptomatic patients.

“These findings highlight the harms of urinalysis overuse in the patient population because positive urinalysis results an introduce cognitive biases in favor of UTI diagnosis even when patients lack accepted guideline-based criteria,” they concluded.

—Michael Potts

Reference:

Yin P, Kiss A, Leis J. Urinalysis order among patients admitted to the general medicine service. JAMA Intern Med. August 2015. [epub ahead of print]. doi:10.1001/jamainternmed.2015.4036.