{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:29:08Z","timestamp":1792189748326,"version":"4.4.0"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X25103097_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the impact of implementation of a conditional reflex urine culturing strategy on urine culture rates, antimicrobial use, and clinical outcomes in hospitalized adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103097_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Pre-post quasi-experimental study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103097_as3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Emergency departments and inpatient units within a large, integrated healthcare system in Northeast Ohio, comprising 10 medical centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103097_as4\">\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Adult patients with a urine culture ordered from June 1, 2018, to May 31, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103097_as5\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A system-wide intervention was implemented on June 1, 2020, requiring urinalysis (UA) with pyuria findings to trigger a urine culture order. We compared urine culture rates, antimicrobial use (measured by days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC]), and clinical outcomes between pre-and post-intervention periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103097_as6\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The intervention resulted in an 85.4% reduction in urine culture rates (0.54 vs 3.71 per 100 patient days). Antimicrobial use decreased, with DOT per 100 patient days dropping by 11.5% and DASC\/DOT by 16.1%. No significant differences were observed in\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      infection rate, subsequent bloodstream infections with urinary pathogens, or mortality between pre- and post-intervention groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103097_as7\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A conditional reflex urine culturing strategy implemented as part of a diagnostic stewardship framework reduced urine culture and antimicrobial use without adverse clinical outcomes. This highlights the potential of diagnostic stewardship to optimize antimicrobial use in hospitalized adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2025.10309","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T07:32:46Z","timestamp":1760081566000},"page":"1228-1233","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Implementation of conditional reflex urine culturing decreases unnecessary antimicrobial use"],"prefix":"10.1017","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9335-6123","authenticated-orcid":false,"given":"Aoi","family":"Yogo","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/051fd9666","id-type":"ROR","asserted-by":"publisher"}],"name":"Case Western Reserve University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2514-3820","authenticated-orcid":false,"given":"Elie A.","family":"Saade","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/051fd9666","id-type":"ROR","asserted-by":"publisher"}],"name":"Case Western Reserve University School of Medicine"},{"name":"University Hospitals Cleveland Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4870-6750","authenticated-orcid":false,"given":"Eric M.","family":"Ransom","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine"},{"name":"University Hospitals Cleveland Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2966-2940","authenticated-orcid":false,"given":"Brigid M.","family":"Wilson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/051fd9666","id-type":"ROR","asserted-by":"publisher"}],"name":"Case Western Reserve University School of Medicine"},{"name":"Louis Stokes Cleveland VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1029-7085","authenticated-orcid":false,"given":"Timothy C.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority"},{"name":"University of Colorado School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5522-2995","authenticated-orcid":false,"given":"Abhishek","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"},{"name":"Respiratory Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0990-4498","authenticated-orcid":false,"given":"Curtis J.","family":"Donskey","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/051fd9666","id-type":"ROR","asserted-by":"publisher"}],"name":"Case Western Reserve University School of Medicine"},{"name":"Louis Stokes Cleveland VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2685-7382","authenticated-orcid":false,"given":"Zainab","family":"Albar","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/051fd9666","id-type":"ROR","asserted-by":"publisher"}],"name":"Case Western Reserve University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren H.","family":"Epstein","sequence":"additional","affiliation":[{"name":"Veterans Affairs Health Care System"},{"name":"Emory University School of 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}