Society for Healthcare Epidemiology of America
View all recommendations from this societyReleased October 1, 2015; Revised December 2, 2019
Don’t perform cultures (e.g. urine, blood, sputum cultures) or test for C. difficile unless patients have signs or symptoms of infection. Tests can be falsely positive leading to over diagnosis and overtreatment.
Although important for diagnosing disease when used in patients with appropriate signs or symptoms, these tests often are positive when an infection is not present. For example, in the absence of signs or symptoms, a positive blood culture may represent contamination, a positive urine culture could represent asymptomatic bacteriuria, and a positive test for C. difficile could reflect colonization. There are no perfect tests for these or most infections. If these tests are used in patients with low likelihood of infection, they will result in more false positive tests than true positive results, which will lead to treating patients without infection and exposing them to risks of antibiotics without benefits of treating an infection.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
A list of approximately 40 potential Choosing Wisely recommendations were collected from members of the SHEA Guidelines, Public Policy and Government Affairs, Antibiotic Stewardship, Education and Publications Committees. From those suggestions, a subgroup of the Guidelines Committee reviewed the list for duplicates and anonymously electronically ranked them. The top fifteen were sent to the SHEA Research Network for a separate ranking. Those that ranked in the top eight were reviewed by the Guidelines Committee for their appropriateness for the Choosing Wisely campaign, and five final recommendations were formally approved via individual member vote by the SHEA Guidelines Committee and the SHEA Board of Trustees.
For SHEA’s disclosure and conflict of interest policy, please visit www.shea-online.org.
Sources
Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA. 1991 Jan 16;265(3):365-9.
Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, Maragakis LL, Sandora TJ, Weber DJ, Yokoe DS, Gerding DN. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Sep;35 Suppl 2:S48-65.
Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Sep;35 Suppl 2:S32-47.
Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019. Epub 2019/03/21. doi: 10.1093/cid/ciy1121. PubMed PMID: 30895288
Peterson LR, Robicsek A. Does my patient have Clostridium difficile infection? Ann Intern Med. 2009 Aug 4;151(3):176-9.
