Majority of pre-surgery UTI screenings unnecessary and may worsen AMR

Aug. 3, 2021

Patients undergoing surgery and other medical procedures are routinely pre-screened for urinary tract infections (UTIs), but the vast majority of these tests are not needed, according to a new investigation by researchers at Massachusetts General Hospital (MGH) as reported in a news release.

The authors of this research letter, published in JAMA Internal Medicine, argue that these unneeded tests not only waste money and resources but also expose patients to potential harms and may worsen the persistent problem of antibiotic resistance.

Clinicians commonly order a urinalysis if a patient has signs and symptoms of a UTI, such as fever and pain with urination. However, unless a UTI is suspected, urinalysis screening is not recommended except in limited circumstances, such as in pregnant women and patients undergoing urological surgery. That’s because bacteria in urine in the absence of symptoms of infection, known as asymptomatic bacteriuria (ASB), is common and does not require treatment.

Patients scheduled for surgery and certain other medical procedures are often instructed to undergo preoperative urinalyses; those with abnormal results may be treated with antibiotics. Many physicians likely order a urinalysis in asymptomatic patients before operating due to concerns that an unidentified urinary infection could result in complications after surgery, explains infectious diseases specialist and healthcare epidemiologist Erica S. Shenoy, MD, PhD, Associate Chief of MGH’s Infection Control Unit. “But the evidence to date does not support screening for and treating ASB for almost all asymptomatic pre-operative patients,” says Shenoy.

Included in the study were 13,169,656 inpatient and outpatient procedures in which urinalysis is not recommended that were performed between 2007 and 2017. These procedures fell into 14 broad categories, such as breast surgery, spine surgery and joint replacement procedures.

The team found that 25% of patients who had these procedures had undergone urinalyses in the 30 days preceding their operations. Within this group, the researchers found that only a small portion (11%) had documented indications consistent with a UTI prior to their procedures, suggesting that a urinalysis was appropriate. In the remaining 89 percent of procedures, urinalyses were performed unnecessarily. Perhaps more concerning, the analysis found that between 5.8 percent and 28.0 percent of patients who had urinalyses without plausible indications of a UTI received prescriptions for antibiotics, depending on which procedure they had.

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