Indication-based clinical decision support for inpatient urine testing: impacts on utilization, appropriateness, and antibiotic prescribing

Antimicrob Steward Healthc Epidemiol.

2026 Jul 24;6(1):e229. eCollection 2026.

PMID: 42534252

PMC13419427

DOI: 10.1017/ash.2026.10805

Abstract

Across a healthcare system, an indication-based clinical decision support (CDS) tool for inpatient urine testing immediately reduced urinalysis-with-reflex-to-culture (-62.7/1,000 patient-days) and urine culture ordering, while increasing urinalysis utilization(41.4/1,000 patient-days). Intervention effect was not fully sustained. Ordering appropriateness remained low, and antibiotics were often prescribed without documented symptoms, suggesting CDS alone is insufficient.