Purposeful microbiology comment added to urine cultures with increases orders for follow-up blood cultures.

Introduction: Patients with bacteriuria (SABU) often have underlying invasive disease, including bacteremia (SAB). It has been proposed that most patients with SABU should have a blood culture done to rule out SAB. A preliminary audit suggested that our local hospitals had a low rate of follow-up blood culture orders for patients with SABU. In response to this, our microbiology laboratory changed the comment appended to urine cultures with growth of to make a more assertive link between SABU and SAB and to recommend follow-up blood cultures.

Aim: We designed a retrospective quasi-experimental study to see if the change in microbiology comment wording had an effect on clinician behaviour. We hypothesized that this simple comment change to make a more assertive link between SABU and SAB would lead to an increase in follow-up blood culture orders.

Methodology: We used microbiology records to identify adult patients with urine cultures positive for at three acute-care hospitals in Hamilton, Ontario, Canada, for 1 year pre- and post-intervention. We recorded urine and blood culture results, timing, patient demographics, and in-hospital mortality.

Results: A total of 243 adult patients with urine cultures with were identified for inclusion. The primary outcome was met, as there was a significant increase in blood culture orders between the pre-intervention and post-intervention groups (66.9 % vs 80.4 %). This difference was mainly driven by an increase for emergency department and urgent care patients (30.6 % vs 63.6 %). The inpatient group had a high baseline rate of blood culture orders that did not change significantly (80.0 % vs 84.7 %). There was no significant change in detection of SAB (23.5 % vs 32.7 %) or inpatient mortality (18.0 % vs 24.7 %).

Conclusion: Our study shows that a simple, purposeful comment appended to urine cultures with leads to a significant increase in follow-up blood culture orders.