Can Reflex Urine Cultures Reduce Your CAUTI Rates? Think Again

Reviewed by: Sonali Advani MBBS, MPH; Duke University School of Medicine

Dougherty and colleagues evaluated the impact of a urine culture standardization program aimed at reducing inappropriate urine cultures that included order indications, standardizing collection techniques and reflexing all urinalysis orders to culture (RUC) if they met specific criteria. This intervention led to a significant reduction in urine cultures, but it resulted in a non-significant increase in urinalyses orders. It is unclear if this intervention led to reduction of urine cultures with higher bacterial threshold (>100,000 colony forming units (CFU)) or lower bacterial thresholds (<100,000 CFU). In addition, catheter-associated urinary tract infection (CAUTI) rates increased post-implementation, which is not unexpected as RUC is not an ideal test for catheterized patients with high incidence of pyuria. While the authors attributed this increase in CAUTI rates to reduction in their denominator (catheter utilization), these rates could have been reported per patient days instead of catheter days to adjust for this. In addition, it would have been useful to know if this intervention impacted antibiotic utilization and hospital-onset bacteremia rates.


Dougherty DF, Rickwa J, Guy D, Keesee K, Martin BJ, Smith J, Talbot TR. Reducing inappropriate urine cultures through a culture standardization program. Amer J Infect Control. 2019 Dec 6. DOI:

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