The Royal College of Pathologists of Australasia
Recommendations from The Royal College of Pathologists of Australasia about urinary tract infections, PSA testing, vitamin D deficiency screening, serum tumor marker tests and hyperlipidaemia. RCPA is the leading organisation representing pathologists and senior laboratory scientists in Australasia. Its mission is to train and support pathologists and to improve the use of pathology testing to achieve better healthcare.
1.
Do not perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection.
Asymptomatic bacteriuria is a common finding in all ages and in association with other comorbidities. Treatment of asymptomatic bacteriuria is recommended in pregnancy but not in other clinical situations.
Prophylaxis against development of symptoms prior to simple cystoscopy and prosthetic joint replacement is not recommended. Extensive guidelines from the Infectious Diseases Society of America (IDSA) are available for this condition and asymptomatic bacteriuria in catheterised patients.
The use of chemical screening strips in asymptomatic patients may lead to unnecessary urine cultures when positive results are obtained. Increasing antibiotic resistance in urinary pathogens may be a consequence of unnecessary treatment.
Supporting evidence
- Nicolle LE. Asymptomatic bacteriuria. Current Opinion in Infectious Diseases 2014;27(1):90-6.
- Nicolle LE, Bradley S, Colgan S, et al. Infectious Diseases Society of America Guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clinical Infectious Diseases 2005;40(5):643-54.
- Gupta K, Hooton TM, Naber KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases 2011;52(5):e103-20.
- Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases 2010;50(5):625-63.
- Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler M, Leibovici L. Antibiotics for asymptomatic bacteriuria. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD009534. DOI: 10.1002/14651858.CD009534.pub2 Available at https://www.cochrane.org/CD009534/RENAL_antibiotic-treatment-for-asymptomatic-bacteriuria.
How this list was made
A list of ten items was compiled after reviewing international literature associated with the Choosing Wisely campaign in Northern America. The College’s advisory committees were canvassed for further relevant evidence based literature and their expert opinions were sought.
The ten items were then adopted as a College Position Statement titled ‘Inappropriate Pathology Requesting’. This list was then sent to RCPA Fellows and Trainees based in Australia to rank the top five tests to include in the Australian Choosing Wisely initiative. The five items selected were approved by both the RCPA's Board of Professional Practice and Quality and the RCPA Board of Directors.
- 1 Do not perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection.
- 2 Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.
- 3 Do not perform population based screening for Vitamin D deficiency.
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4
Restrict the use of serum tumour marker tests to the monitoring of a cancer known to produce these markers. There may be a role, however, for tumour marker measurement in the initial investigation and assessment of high risk or symptomatic individuals.
- 5 Do not routinely test and treat hyperlipidemia in those with a limited life expectancy.