# Diagnostic Efficiency in Urinary Tract Infection: Evaluation of a Comprehensive Intervention Based on Clinical Conditions, Urinalysis, and Gram Staining

## TL;DR

This study shows that using a new protocol for diagnosing UTIs can significantly reduce unnecessary tests and costs without harming patient outcomes.

## Contribution

A new protocol combining clinical and lab data reduces unnecessary urine cultures and costs for UTI diagnosis.

## Key findings

- The intervention reduced urine culture processing by 71% and 84% during and after implementation.
- No significant differences in readmission or mortality were observed after the intervention.
- The protocol led to an 84.05% cost reduction compared to the preintervention period.

## Abstract

Introduction: Urinary tract infection (UTI) is the second most common cause of infection globally, following respiratory system infections. The aim is to evaluate the effectiveness of an optimization strategy in the diagnosis of UTIs through the patient’s clinical condition and laboratory tests, with the purpose of reducing unnecessary urine culture processing, reducing antibiotic treatment of asymptomatic bacteriuria, and improving the diagnostic accuracy of UTIs.

Methods: A quasi-experimental study was conducted in a high-complexity hospital’s emergency department from January to September 2024. Adult patients with suspected UTIs were included. The intervention, implemented in April, consisted of a protocol created by the Antimicrobial Stewardship Program for diagnostic accuracy of UTIs. Data on sociodemographic, clinical, laboratory, and cost-related variables were analyzed.

Results: A total of 1,376 urine cultures were included. The intervention showed a statistically significant (p < 0.001) decrease in the processing of urine culture in the intervention and postintervention group, with 71% and 84% less urine cultures processed than the preintervention group, respectively. No differences were found (p = 0.384) in readmission due to UTI within the next 30 days or in mortality (p = 0.488). The intervention reduced the number of urine cultures collected, leading to an 84.05% decrease in costs compared to the preintervention period.

Conclusion: The implementation of an optimized urine culture protocol that incorporates clinical conditions and laboratory tests can lead to a significant reduction in costs and waste, while also promoting better optimization of available resources.