Appropriateness of urine culture requests in primary care in Spain: A cross-sectional descriptive study.

Abstract

Objective: Studies evaluating urine culture requests in our country have highlighted a high rate of requests that fall outside the indications specified in clinical guidelines. We evaluated the current degree of inadequacy in the request of urine cultures and how this influences the therapeutic decisions of general practitioners.

Design: Cross-sectional descriptive study.

Setting: Three primary care centres in Tarragona area.

Participants: Urine culture requests from the adult population≥18 years old, received at the Microbiology Service of the reference hospital in 2022. All requests were made in primary care settings.

Main measures: The collected variables included sociodemographic data, urinary tract infection (UTI) symptoms at the time of the urine culture request, comorbidities, reason for the request (including diagnosis), type of urine culture, therapeutic approach before and after receiving the result, and the urine culture result.

Results: A total of 461 urine cultures were reviewed: 152 men (mean age 64.1 years) and 309 women (mean age 57 years). Of the urine cultures analyzed, 17.4% were for cystitis (22% in women), 2.4% for pyelonephritis, 1.3% for complicated UTIs, and 1.5% for asymptomatic bacteriuria. In 10.6%, they were for recurrent UTIs; in 9.6%, post-treatment. In 55.5% of cases, general practitioners continued without antibiotic treatment, regardless of urine culture results. The reason to request was unknown in 18.9%. Antibiotic changes occurred in 5.6%.

Conclusions: There is still a high rate of urine culture over-requesting in primary care, with 20% of cultures being ordered for otherwise uncomplicated UTIs. While the methodology of the project does not allow for causal analysis, it provides a detailed description of clinical practices in primary care.