CLINICAL UTILITY OF ROUTINE URINALYSIS (UA) SCREENING FOR INFECTION IN TRANSPLANT (TP) PATIENTS (PTS)

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369 In our TP clinic, a UA was obtained at every visit without regard to clinical indications. The purpose of this study was to evaluate how transplant clinicians used this information, and determine the impact on clinical outcome. Methods: We retrospectively reviewed the results of routine UA on 283 asymptomatic pts. attending clinics from 9/97-12/97. Pts already on antibiotic treatment (ATB Rx) prior to visit were excluded. UA was considered abnormal if any of the following present: leukocyte esterase (LE) +, nitrite +, WBC >5, RBC >4, or bacteria seen (based on our laboratory normal values). Clinical interventions based on the findings were performed at the discretion of the attending physician. Medical record review was performed ≥1 mo. after initial UA to determine outcomes such as later need for ATB Rx, voiding symptoms, physician visits or hospitalization. Results: UA was normal in 182 pts (64%). 102 pts (36%) had one or more abnormalities on UA. Repeat UA was obtained in 39 pts (14%). 16 pts (6%) required ATB Rx (11 after initial clinic UA, 5 after repeat UA). Most pts given ATB Rx had positive urine culture, and history of urinary infection and/or urinary tract abnormalities. Findings in pts with + UA: Only 4 pts (1.4%) had positive nitrite. Other abnormal UA findings - # of patients(%): (Table)TableThere was no difference in abnormalities (in number or severity) between those judged to need treatment and those not treated. Followup disclosed no evidence of a negative outcome (repeat clinic, ER or local MD visit; phone report of symptoms, course of ATB Rx or hospitalization) in any untreated patient with abnormal UA. Conclusion: Abnormal findings on routine UA are common in asymptomatic TP pts, do not predict need for ATB Rx in clinical practice, and (in the short term) do not predict negative outcome in untreated pts. UA in selected subset of TP pts would probably be a better clinical strategy.

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