Do urine cultures for urinary tract infections decrease follow-up visits?

Abstract

Background: No major clinical practice guideline recommends ordering a urine culture in the management of uncomplicated urinary tract infections (UTIs). In this era of increasing antibiotic resistance, our objective was to determine if ordering urine cultures for adult women with uncomplicated UTIs provides results that lead to a decrease in follow-up visits for continued UTI symptoms. Methods: This was a retrospective cohort study from the outpatient family medicine clinic, Madigan Army Medical Center, Tacoma, WA. Seven hundred seventy-nine nondiabetic, nonpregnant, adult (aged 18-65 years) female patients (mean age ± SD, 32.9 ± 12.1 years) diagnosed with a UTI from November 2006 through March 2008. The main outcome measure was follow-up outpatient visits within 2 weeks for recurrent UTI symptoms. Results: Of the 779 patients studied, 332 (43%) had no urine culture ordered as part of their management and 447 (57%) had a urine culture ordered. There was no significant difference in the rate of follow-up within 2 weeks for continued UTI symptoms between the cohort without urine culture (28 of 332; 8.4%) and the cohort with urine culture (39 of 447; 8.7%) (χ 2 = 0.021; P = .89). In multivariate logistic regression, ordering a urine culture was not associated with a decreased rate of follow-up visits (adjusted odds ratio, 1.11; 95% CI, 0.65-1.90). Conclusions: In adult women with uncomplicated UTI, ordering a urine culture was not found to be associated with a decrease in follow-up clinic visits. This finding is consistent with current guidelines that recommend against ordering a urine culture for uncomplicated UTIs.