Choosing Wisely Canada—Top five list in medical microbiology: An official position statement of the Association of Medical Microbiology and Infectious Disease (AMMI) Canada

Abstract

Background: Choosing Wisely Canada is a forum for health care professional societies to lead system change through identification and reduction of low-value practices. Microbiologic investigations are frequently overused and may contribute to unnecessary health care expenditures as well as patient harm. Methods: A Choosing Wisely Canada top five list in medical microbiology was developed by the Association of Medical Microbiology and Infectious Disease (AMMI) Canada through broad consultation of its members. Following an electronic survey of members, recommendations were developed and ranked by a working group, then further narrowed during a national open forum using the modified Delphi method. Feedback was solicited through an online forum prior to dissemination. Results: The top five declarative statements in medical microbiology are: ( 1 ) Don’t collect urine specimens for culture from adults who lack symptoms localizing to the urinary tract or fever, ( 2 ) Don’t routinely collect or process specimens for Clostridium difficile testing when stool is non-liquid or if the patient has had a prior nucleic acid amplification test result within the past 7 days, ( 3 ) Don’t obtain swabs from superficial ulcers for culture, ( 4 ) Don’t routinely order nucleic acid amplification testing on cerebrospinal fluid in patients without a compatible clinical syndrome, and ( 5 ) Don’t routinely obtain swabs during surgical procedures when fluid and/or tissue samples can be collected. Conclusions: This Choosing Wisely list represents a launching point to reduce low-value practices in microbiology. Strong implementation science around these statements will be needed to improve the value of microbiology testing in Canada.