LAUSR

available at http://pubmed.ncbi.nlm.nih.gov/29397230 Editorial Comment: The authors implemented a multipronged or “bundled” approach to reduce catheter associated (CA) urinary tract infection (UTI) in trauma cases. The 2 categories of process optimization are 1) proper use and early discontinuation of the catheter, which is a common approach at many hospitals, and 2) raising the threshold for even obtaining a urine culture. The second approach is more interesting and was like music to my ears, and probably the ears of any urologist. The authors recognize that many of these positive cultures represent asymptomatic bacteriuria and that it is better not to culture because once you have a positive culture and a fever, you have to report it as a CAUTI. To reduce over detection of asymptomatic bacteriuria as a UTI, in patients with suspected CAUTI the authors 1) replaced the catheter and drew the culture off the new catheter, 2) always checked a urinalysis (UA) and only sent a culture off the urine sample if the UA showed more than 10 white blood cells per high power field, and 3) prospectively monitored urine cultures and canceled any that might have been accidentally ordered if the UA was negative. They recognize that there are many other explanations for a fever in patients with trauma and that it is best not to go looking for a UTI unless one really suspects it as the cause of fever based on clinical symptoms or a positive UA. This concept seems obvious to us as urologists and speaks to why we need to be involved in these CAUTI monitoring programs.