Optimized Urinalysis Reflex Reduces Urine Culture Orders in MS

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This quality improvement project seeks to reduce the rate of unnecessary treatments.
This quality improvement project seeks to reduce the rate of unnecessary treatments.
The following article is part of conference coverage from the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tennesssee. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2018.

The first phase of a 3-phase quality improvement study has shown a decrease in orders of urine cultures as a result of urinalysis reflex orders in people with multiple sclerosis (MS) and other central nervous system (CNS) demyelinating diseases. This research was presented at the 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 30-June 1, 2018, in Nashville, Tennessee.

Phase 1 of this study was performed using subjects in the Ochsner Multiple Sclerosis Center who had CNS demyelinating diseases, including MS.

To avoid unnecessary urine cultures, the study researchers performed a urinalysis reflex order that only prompted a urine culture when white blood cell count was greater than 10 cells per high-power field.

Before intervention, there was an 87% rate of urinalyses resulting in urine cultures. After implementing phase 1, this figure dropped to 55%. However, there was no statistically significant drop in antibiotic prescriptions.

Phase 2 of this study will create a standardized system for urine collection materials, perform a trial of a preservative collection tube intended to reduce contamination, and educate subjects via handouts. Phase 3 will integrate interventions from phases 1 and 2 to further decrease the rate of antibiotic prescription.

Due to the increased risk for urinary tract infections (UTIs) in people with MS and similar CNS demyelinating diseases, as well as the tendency of UTIs to trigger more MS flares, the affected population are subject to a large number of unneeded antibiotic prescriptions and asymptomatic bacteriuria treatments. This quality improvement project seeks to reduce the rate of unnecessary treatments.

The study researchers concluded that “[data] from phase 1 demonstrated that the urinalysis reflex order decreased the number of urine cultures ordered. The small sample size of phase 1 limited the ability to draw conclusions regarding a decrease in frequency of antibiotic prescriptions.”

For more coverage of CMSC 2018, click here.

Reference

Smith TE, Baumgarten K, Hand J, Peskin AE, Bagert BA. Quality improvement: optimizing antibiotic use and bacteriuria screening in patients with multiple sclerosis and other central demyelinating diseases. Poster presentation at: 2018 CMSC Annual Meeting. May 30-June 1, 2018; Nashville, TN. Abstract MD07.

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