No "other" way: modification of urinalysis-driven reflex urine culture protocol to reduce inpatient urine cultures.

Authors

Mackenzie Rae Keintz, Jasmine R Marcelin, Elizabeth Lyden, Mark E Rupp, Trevor C Van Schooneveld

Published in

Infection control and hospital epidemiology. Pages 1-6. Oct 14, 2026. Epub Oct 14, 2026.

Abstract

To evaluate the impact of removing the "other" free text special indication from an inpatient urinalysis (UA)-driven reflex urine culture UTI panel on urine culture utilization and special indication designation.
Single-center interrupted time series analysis using segmented regression to assess changes in urine culture ordering before and after intervention.
Tertiary academic medical center inpatient units, July 1, 2022-October 31, 2025.
All hospitalized adults with UTI panels during the study period. Urine culture orders from emergency and ambulatory settings were excluded.
Removal of the "other" free text special indication from the UTI panel in February 2024. A new "deceased donor" special indication was added to maintain compliance with local organ procurement regulations.
Among 39,218 UTI panels, 11,923 cultures were performed. Postintervention urine cultures decreased by 2.09 per 1,000 patient days (PD) (P <.05), with a significant postintervention downward trend of 0.15 cultures per 1,000 PD per month (P <.05). Special indication designation decreased immediately by 2.17 special indications per 1,000 PD (P <.05) with a reversal of the preintervention upward trend (P <.05). Designation for neutropenia increased by 0.74 indications per 1,000 PD immediately postintervention (P <.05); renal/pancreas transplant and pregnancy indications remained stable or declined. No compensatory increase in total urine cultures was observed.
Removing the "other" free text option in a UTI panel led to a sustained reduction in overall urine culture ordering and low-value special indication designations. Modifying electronic order set architecture represents a feasible diagnostic stewardship strategy to reduce unnecessary testing and potential overtreatment of asymptomatic bacteriuria while preserving pathways for high-risk populations.

PMID:
42870557
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

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