ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Clinical and Diagnostic Microbiology and Immunology
Volume 15 - 2025 | doi: 10.3389/fcimb.2025.1572936
This article is part of the Research TopicAdvances in the Diagnosis and Management of Infectious DiseasesView all 20 articles
Impact of Discontinuing Automatic Reflex Urine Culture After Urinalysis: A Diagnostic and Antibiotic Stewardship Initiative
Provisionally accepted
- 1Baylor Scott and White Health, Temple, New Hampshire, United States
- 2Central Texas Veterans Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Temple, Texas, United States
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This study aims to assess the impact of discontinuing reflex urine cultures based on urinalysis results (positive for nitrates and/or leukocyte esterase) on diagnostics, antibiotic usage, and laboratory efficiency at the Central Texas Veterans' Health Care System (CTVHCS). It seeks to evaluate whether stopping reflex testing reduces unnecessary antibiotic use, enhances antibiotic stewardship, and improves the processing of clinically relevant specimens. A six-year retrospective analysis was conducted, comparing data from three years before and after the 2018 policy change, which discontinued reflex urine culture unless specifically requested by healthcare providers suspecting UTI symptoms. The study analyzed the number of processed urine cultures, positivity for uropathogens, and antibiotic usage trends before and after the policy change. The policy change resulted in a significant reduction in processed urine cultures. There was also a notable decrease in ciprofloxacin usage and an increase in the use of nitrofurantoin, indicating a shift towards narrower-spectrum antibiotics. Stopping reflex testing reduced the lab burden by focusing on clinically relevant cases of UTIs and supported improved antibiotic stewardship. This enabled healthcare providers to selectively order culture and sensitivity, targeting true UTIs.
Keywords: Asymptomatic bacteriuria, Urinalysis Reflex, UTI, Uropathogen, urine culture
Received: 07 Feb 2025; Accepted: 19 Sep 2025.
Copyright: © 2025 Berger, Lukey, Jinadatha and Navarathna. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dhammika Navarathna, dhammika.navarathna@va.gov
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