RISK FACTORS FOR POSITIVE URINE CULTURE PRIOR TO REFERRAL TO UROGYNECOLOGY CLINIC
ROLSTON1, A. GOEBEL 2, C. HORTON 1, V. VELASCO 3, C. E. DANCZ 2, B. OZEL 2;
1Female Pelvic Medicine & Reconstructive Surgery, LAC+USC Med. Ctr., Los Angeles, CA, 2LAC+USC Med. Ctr., Los Angeles, CA, 3Obstetrics & Gynecology, LAC+USC Med. Ctr., Los Angeles, CA.
Introduction: The American Urological Association recommends obtaining a urine analysis, and urine culture if indicated, for the initial work up of urinary incontinence in women. The current practice at our institution is to send either a urinalysis, urine culture or both prior to referring a patient to urogynecology clinic.
Objective: Our aim was to determine the rate and predictors of positive urine culture among women referred to urogynecology clinic.
Methods: A retrospective chart review was performed on all new urogynecology clinic visits at a single institution from June 1, 2015 to July 1, 2016. Patient characteristics including age, parity, height, weight, symptoms of stress incontinence, urgency incontinence, fecal incontinence or prolapse, presence of diabetes mellitus (DM), prior hysterectomy, tobacco use, prolapse stage, urinalysis and urine culture results and treatment with antibiotics prior to initial urogynecology clinic appointment were recorded. A positive urine culture was defined as the presence of known uropathogens with a colony count of 10^4 or greater. A urine dipstick highly suspicious for infection was defined as the presence of moderate or large leukocyte esterase or positive nitrites. Descriptive analysis was performed for categorical and continuous variables. Statistical analysis was performed with Student's t-test and Fisher's exact test to compare patients with a positive urine culture versus those with a negative urine culture.
Results: A total of 349 charts were reviewed. 196 women had a documented urine culture performed prior to referral to urogynecology clinic. The mean age was 54 (26-86) years; median parity 3 (0-11); mean body mass index (BMI) was 30.6 (16.7-47.9) kg/m2. A total of 141 (71.9%) women had symptoms of stress incontinence; 115 (58.7%) had symptoms of urgency incontinence; 7 (3.6%) had symptoms of fecal incontinence; 104 (53.1%) women had symptoms of prolapse; 61 (31.1%) women had DM; 31 (15.8%) women had prior hysterectomy; 13 (6.6%) women were current tobacco smokers; and 101 (51.5%) women had prolapse stage greater than or equal to 2. Of the 196 women analyzed, 40 (20.4%) had a positive urine culture: 14 (35%) for Escherichia coli; 9 (22.5%) for Group B Streptococcus; 6 (15%) for Streptoccoccus viridans; 3 (7.5%) for Klebsiella pneumoniae; 2 (5%) for Enteroccoccus faecalis; and 6 (15%) revealed other bacteria. Of those with a positive culture, 23 (57.5%) were treated. Between the group of women with a negative urine culture and those with a positive urine culture, there was no difference in age (p=0.60), parity (p=0.50), BMI (p=0.75), history of prior hysterectomy (p=0.22), current tobacco use (p=1.00), or prolapse stage greater than or equal to 2 (p=1.00). There was also no difference in symptoms of stress incontinence (p=0.69), urgency incontinence (p=0.1.00), fecal incontinence (p=0.61) or prolapse (p=0.71) between the two groups. The presence of DM was noted to be statistically significant between women with positive urine cultures compared to women with a negative culture, 45% vs. 27.5%, respectively (OR=2.2, p=0.035). Women with positive urine cultures were significantly more likely to have a urine dipstick that was highly suspicious for infection (48.7% vs. 8.2%; OR 10.6, p<0.0001)
Conclusions: About one fifth of women referred to the urogynecology clinic had positive urine cultures. The only risk factor identified in our patient population for a positive urine culture was DM. Almost one third of women with DM had a positive urine culture. Urine culture should be considered in the evaluation of women with lower urinary tract symptoms prior to urogynecology clinic referral, especially in women with DM and urine dipstick positive for moderate or large leukocyte esterase or positive nitrites.