Do think twice, it’s alright: Utility of urine cultures in febrile neutropenia after HSCT

Reviewed by: Jose Lucar, MD, The George Washington University

Antimicrobial resistance creates challenges in the effective management of individuals undergoing hematopoietic stem cell transplantation (HSCT), and as such, both antimicrobial and diagnostic stewardship are increasingly recognized as priorities to improve care. In this single-center retrospective study, Tran and colleagues evaluated the value of urine cultures in the management of adult patients with febrile neutropenia (FN) during their first hospitalization (2014-2021). They found that among 667 patients with FN, 40 (6%) had asymptomatic bacteriuria, 7 (1%) had documented urinary tract symptoms, and only 1 of those 7 patients had a positive urine culture. Overall, antibiotic changes were made in only 3 (0.4%) patients in response to urine culture results, and no patients developed pyelonephritis, UTI-related bacteremia, or escalation of care due to UTI. While further study is needed, these results suggest that obtaining urine cultures during the workup of patients with FN after HSCT is of minimal value in the absence of urinary symptoms. 

Tran M, Palmer S, Moore DT, Bartelt L, et al. Utility of urine cultures during febrile neutropenia workup in hematopoietic stem cell transplantation recipients without urinary symptoms, Open Forum Infectious Diseases, 2023; ofad236.

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