Urine culture and urinalysis utilization practices in United States acute care hospitals between 2017 and 2020

Q: What problem does the study address regarding urine cultures and urinalysis?

Inappropriate urine cultures are common and can lead to inappropriate antimicrobial use. The study focuses on how UA use within diagnostic stewardship may affect nationwide UC and UA utilization patterns.

Q: How was a positive urinalysis defined in the study?

A positive UA was defined as more than 10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite.

Q: What trends in urine culture utilization were found from 2017 to 2020?

Overall UC rates decreased from 2017 to 2020. The proportion of UCs with a positive UA increased over the same period, while UCs without a UA decreased.

Sep 30, 2026

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Objective: Inappropriate urine cultures (UCs) are common and drive unnecessary antimicrobial use. Urinalyses (UAs) are increasingly used in diagnostic stewardship, but national impacts remain unclear. This retrospective cohort study assessed UA and UC utilization among adults (≥18) hospitalized in U.S. acute care settings using the PINC AI™ Healthcare Database (2017–2020). Positive UA required >10 leukocytes/high power field or leukocyte esterase/nitrite positivity. Results and trends describe changing UC rates, UA positivity proportions, and predictors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Abstract

Objective

Methods

Results

Conclusions

Introduction

Author Manuscript Author Manuscript Author Manuscript Author Manuscript | | HHS Public Access
Author manuscript
Infect Control Hosp Epidemiol. Author manuscript; available in PMC 2025 November 19. | | --- | --- | Published in final edited form as: Infect Control Hosp Epidemiol. 2026 January ; 47(1): 71–79. doi:10.1017/ice.2025.10260 . Urine culture and urinalysis utilization practices in United States acute care hospitals between 2017 and 2020 Nyawung L. Asonganyi, MPH 1,2 , Sophia V. Kazakova, MD, MPH, PhD 1 , Kelly M. Hatfield, DrPH, MSPH 1 , James Baggs, PhD 1 , Scott K. Fridkin, MD2,3,4 , Sujan C. Reddy, MD, MSc 1 , Joseph Daniel Lutgring, MD 1 1 Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA 3 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA 4Georgia Emerging Infections Program, Decatur, Georgia, USA Abstract Objective: Inappropriate urine cultures (UCs) are common and lead to inappropriate antimicrobial use. Urinalyses (UAs) have been increasingly incorporated into diagnostic stewardship interventions, but the impact of these interventions nationally has not been assessed. We describe UA and UC utilization practices using a nationwide dataset of patients admitted to acute care hospitals. Methods: Design, Setting and Participants: We performed a retrospective cohort study of index UCs and their associated UAs performed for adult patients (age ≥ 18 years) admitted in U.S. acute care hospitals, participating in the PINC AI™ Healthcare Database (PHD) from January 1, 2017, through December 31, 2020. A positive UA was defined as >10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite. Results: The overall rate of UCs in this study was 124.7 per 1000 discharges and annual UCrates decreased from 2017 (129.2) to 2020 (120.0) . The proportion of UCs that had a positive UA increased from 60 .5% in 2017 to 68 . 1% in 2020; UCs without a UA decreased from 19.3% to 10.5%, and UCs with a negative UA did not significantly change (20.2% to 21.5%) . A multivariate multinomial logistic regression model identified male sex, age <65, and a diagnosis of cancer to be predictors of having a UC with a negative UA or no UA. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited. Corresponding author: Joseph Daniel Lutgring; [yix4@cdc.gov](yix4@cdc.gov). Previous Presentation: These findings were presented in part at IDWeek 2023 in Boston, Massachusetts, USA. Author Manuscript Author Manuscript Author Manuscript Author Manuscript Asonganyi et al. Page 2 Conclusions: UC utilization decreased over the study period. The proportion of UCs with a positive UA increased. This may suggest a positive impact of diagnostic stewardship practices atthe national level although further progress is needed. Introduction Urinary tract infections (UTIs) are common among hospitalized patients.1,2 Approximately 20% of all hospitalized patients receiving antimicrobial therapy are being treated for a UTI.3 The diagnosis of UTI is principally based on signs and symptoms, but a urinalysis (UA) can assist with the diagnosis.4–6 It may detect either pyuria (presence of leukocytes or leukocyte esterase) or bacteriuria (presence of bacteria or nitrite) . One meta-analysis found that presence of leukocyte esterase or nitrite had a likelihood ratio of 4.2 and the absence of both had a likelihood ratio of 0.3 for UTI.4,7 A urine culture (UC) can further assist with guiding antimicr

FAQs

What problem does the study address regarding urine cultures and urinalysis?

Inappropriate urine cultures are common and can lead to inappropriate antimicrobial use. The study focuses on how UA use within diagnostic stewardship may affect nationwide UC and UA utilization patterns.

How was a positive urinalysis defined in the study?

A positive UA was defined as more than 10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite.

What trends in urine culture utilization were found from 2017 to 2020?

Overall UC rates decreased from 2017 to 2020. The proportion of UCs with a positive UA increased over the same period, while UCs without a UA decreased.

Sep 30, 2026

Upload by Jiven