15 - Leveraging Data to Explore the Consequences of Urine Testing and Antibiotic Use During the Spinal Cord Injury Annual Evaluation

Background: The Veterans’ Health Administration (VHA), currently mandates that every spinal cord injury and disorder (SCI/D) patient receives a screening urinalysis and urine culture (UC) during the annual evaluation (AE). Our pilot study at a single VHA center showed that 87% of the UCs obtained during the AE represented asymptomatic bacteriuria (ASB), and that 35% of those UC were treated with antibiotics unnecessarily. The objective of the current study is to determine the association between UC and antibiotic use using a national VHA sample of SCI/D patients.

Methods: Retrospective cohort of Veterans who presented to a VHA SCI/D clinic for their AE in FY18 or FY19. Demographic and clinical characteristics  as well as information on primary outcomes (receipt of urine culture and antibiotics)  were extracted from the VHA Corporate Data Warehouse.  Associations between covariates and outcomes were assessed using logistic regression. P values < 0.05 were considered significant.

Results: 9447 veterans with SCI/D were included, of whom 5088 (54%) had a UC obtained. Of those with a UC, 2910 (57%) were classified as positive (Figure 1). 1054 (11%) veterans were prescribed antibiotics within 7 days of their AE. Of these, 515 had a positive UC, 202 had a negative UC, and 2878 did not have a UC obtained during the AE. Age, ethnicity, neurologic level of injury (NLI), comorbidity score, frequently identified organism on positive culture, and receipt of antibiotics within 7 days of AE were significantly associated with obtaining a UC during the AE.  Race, NLI, bladder management strategy, comorbidity score, frequently identified organism on positive culture, and having a UC obtained during the AE were significantly associated with receipt of antibiotics within 7 days of AE.Flowchart of SCI/D Veterans who had a urine culture and/or received antibiotics during their FY18/19 AE


Conclusion: Over half of Veterans with SCI/D presenting for their AE receive a screening UC, contrary to other national guidelines recommending against this practice.  Age and type or organism identified on UC drive antibiotic use, which was similar to our previous findings and reflect themes identified during our qualitative interviews with SCI/D providers. The knowledge gained from this national VA study will assist the development of interventions to reduce unnecessary urine testing and antibiotic use in the SCI/D population.

Co-Author(s)

• SM

  Sarah B. May, MS, MPH

  Research Coordinator
  Baylor College of Medicine
  Houston, Texas

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AW

  Annette Walder, MS

  Statistician
  Center for Innovations in Quality, Effectiveness and Safety
  Houston, Texas

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SH

  S. Ann Holmes, MD

  Associate Professor
  Baylor College of Medicine
  Houston, Texas

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• IP

  Ivy Poon, PharmD

  Professor
  Texas Southern University
  Houston, Texas

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Charlesnika T. Evans, PhD, MPH

  Associate Professor and Research Health Scientist
  Northwestern University and VA
  Hines, Illinois

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Barbara Trautner, MD, PhD

  Professor of Medicine
  Michael E DeBakey VA Medical Center
  Houston, Texas

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Presenting Author(s)

• 

  Felicia Skelton, MD, MS

  Assistant Professor
  Baylor College of Medicine
  Houston, Texas

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

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