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Chapter 3.12 : Urine Cultures

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Abstract:

Urinary tract infections (UTI) account for seven million visits to physicians' offices and over one million hospital admissions per year. Epidemiological studies by E. H. Kass ( ) have shown that bacterial counts of ≥10 CFU/ml for a pure culture of gram-negative bacilli were found to be associated with acute bacterial infections of the urinary tract. In females with dysuria and acute UTI, other investigators reported that 10 CFU/ml can be significant ( ). For infants and catheterized patients, low counts also have been shown to be significant ( ). Because of the importance of colony counts for infection, urine cultures are always performed with an accompanying colony count ( ).

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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Figures

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Figure 3.12-1

(a) Method of streaking urine for colony count using a 0.001-ml loop; (b) method of streaking urine for colony count using either a 0.01- or 0.001-ml loop; (c) spreader method of streaking urine for colony count after inoculation with either a 0.01- or 0.001-ml volume; (d) method of streaking 0.01 ml of urine using drip method for count and quadrant streaking for isolation; (e) MAC-CNA biplate with 0.01 ml of urine streaked in quadrants (EMB and PEA are other options).

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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Figure 3.12-A1

Flowchart for forward pipetting (adapted from reference with permission).

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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Figure 3.12-A2

Flowchart for reverse pipetting (adapted from reference with permission).

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
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References

/content/book/10.1128/9781555817435.chap3.12
1. Albers, A. C.,, and R. D. Fletcher. 1983. Accuracy of calibrated-loop transfer. J. Clin. Microbiol. 18:4042.
2. Clarridge, J. E.,, J. R. Johnson,, and M. T. Pezzlo,. 1998. Cumitech 2B, Laboratory Diagnosis of Urinary Tract Infections. Coordinating ed., A. L. Weissfeld. American Society for Microbiology, Washington, DC.
3.Clinical and Laboratory Standards Institute.2004. Quality Assurance for Commercially Prepared Microbiological Culture Media, 3rd ed. Approved standard M22-A3. Clinical and Laboratory Standards Institute, Wayne, PA.
4. Dejulius, K. L.,, K. Smith,, S. Parshall,, D. Warner,, L. Foy,, P. Shah,, A. Miskov,, S. Schindler,, G. W. Procop,, and G. Hall. 2004. Use of BBL CHROMagar Orientation Media for the identification and enumeration of urinary tract pathogens: comparison to routine culture techniques. Presented at the 104th General Meeting of the American Society for Microbiology, New Orleans, LA.
5. Gross, P. A.,, L. M. Harkauy,, G. E. Barden,, and M. Kerstein. 1974. The fallacy of cultures of the tips of Foley catheters. Surg. Gynecol. Obstet. 139:597598.
6. Heldrich, F. J.,, M. A. Barone,, and E. Spiegler. 2000. UTI: diagnosis and evaluation in symptomatic pediatric patients. Clin. Pediatr. (Philadelphia) 39:461472.
7. Hoberman, A.,, E. R. Wald,, L. Penchansky,, E. A. Reynolds,, and S. Young. 1993. Enhanced urinalysis as a screening test for urinary tract infection. Pediatrics 91:11961199.
8. Hooton, T. M.,, and W. E. Stamm. 1997. Diagnosis and treatment of uncomplicated urinary tract infection. Infect. Dis. Clin. N. Am. 11:551581.
9. Johnson, J. R.,, and W. E. Stamm. 1989. Urinary tract infections in women: diagnosis and treatment. Ann. Intern. Med. 111:906917.
10. Kass, E. H. 1956. Asymptomatic infections of the urinary tract. Trans. Assoc. Am. Phys. 69:5664.
11. Lifshitz, E.,, and L. Kramer. 2000. Outpatient urine culture: does collection technique matter? Arch. Intern. Med. 160:25372540.
12. Lin, D. S.,, F. Y. Huang,, N. C. Chiu,, H. A. Koa,, H. Y. Hung,, C. H. Hsu,, W. S. Hsieh,, and D. I. Yang. 2000. Comparison of hemocytometer leukocyte counts and standard urinalyses for predicting urinary tract infections in febrile infants. Pediatr. Infect. Dis. J. 19:223227.
13. Lipsky, B. A.,, R. C. Ireton,, S. D. Fihn,, R. Hackett,, and R. E. Berger. 1987. Diagnosis of bacteriuria in men: specimen collection and culture interpretation. J. Infect. Dis. 155:847854.
14. Pezzlo, M. T.,, D. Amsterdam,, J. P. Anhalt,, T. Lawrence,, N. J. Stratton,, E. A. Vetter,, E. M. Peterson,, and L. M. de la Maza. 1992. Detection of bacteriuria and pyuria by URISCREEN, a rapid enzymatic screening test. J. Clin. Microbiol. 30:680684.
15. Pfaller, M. A.,, B. Ringenberg,, L. Rames,, J. Hegeman,, and F. Koontz. 1987. The usefulness of screening tests for pyuria in combination with culture in the diagnosis of urinary tract infection. Diagn. Microbiol. Infect. Dis. 6:207215.
16. Shaw, K. N.,, K. L. McGowan,, M. H. Gorelick,, and J. S. Schwartz. 1998. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics 101:15.
17. Stamm, W. E.,, G. W. Counts,, K. R. Running,, S. Fihn,, M. Turck,, and K. K. Holmes. 1982. Diagnosis of coliform infection in acute dysuric women. N. Engl. J. Med. 307:463468.
18. Stark, R. P.,, and D. G. Maki. 1984. Bacteriuria in the catheterized patient: what quantitative level of bacteriuria is relevant? N. Engl. J. Med. 311:560564.
19. Tambyah, P. A.,, and D. G. Maki. 2000. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch. Intern. Med. 160:678682.
20. Tambyah, P. A.,, and D. G. Maki. 2000. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch. Intern. Med. 160:673677.
21. Washington, J. A., II,, C. M. White,, M. Laganiere,, and L. H. Smith. 1981. Detection of significant bacteriuria by microscopic examination of urine. Lab. Med. 12:294296.
22. Zhang, Q.,, C. Kwoh,, S. Attorri,, and J. E. Clarridge III. 2000. Aerococcus urinae in urinary tract infections. J. Clin. Microbiol. 38:17031705.
1. Pezzlo, M. T.,, D. Amsterdam,, J. P. Anhalt,, T. Lawrence,, N. J. Stratton,, E. A. Vetter,, E. M. Peterson,, and L. M. de la Maza. 1992. Detection of bacteriuria and pyuria by URISCREEN, a rapid enzymatic screening test. J. Clin. Microbiol. 30:680684.
2. Semeniuk, H.,, J. Noonan,, H. Gill,, and D. Church. 2002. Evaluation of the Coral UTI ScreenTM system for rapid automated screening of significant bacteriuria in a regional centralized laboratory. Diagn. Microbiol. Infect. Dis. 44:710.
1. Albers, A. C.,, and R. D. Fletcher. 1983. Accuracy of calibrated-loop transfer. J. Clin. Microbiol. 18:4042.
2. Clarridge, J. E.,, M. T. Pezzlo,, and K. L. Vosti. 1987. Cumitech 2A, Laboratory Diagnosis of Urinary Tract Infections. Coordinating ed., A. S. Weissfeld. American Society for Microbiology, Washington, DC.
1. Bermes, E. W.,, and D. T. Forman,. 1976. Basic laboratory principles and procedures, p. 615. In N. W. Teitz (ed.), Fundamentals of Clinical Chemistry, 2nd ed. The W. B. Saunders Co., Philadelphia, PA.
2.Bio-Rad Laboratories. 1983. Procedure for comparing precision of pipet tips. Clin. Lab. Prod. 12:15.
3. Bray, W. 1995. Software for the gravimetric calibration testing of pipets. Am. Clin. Lab. 14:1415. (Available on the internet at http://www.labtronics.com/ptM_art.htm)
4. Connors, M.,, and R. Curtis. 1999. Pipetting error: a real problem with a simple solution. Parts I and II. Am. Lab. Newsl. 31:2022.
5. Curtis, R. H. 1994. Performance verification of manual action pipets. Part I. Am. Clin. Lab. 12:89.
6. Curtis, R. H. 1994. Performance verification of manual action pipets. Part II. Am. Clin. Lab. 12:1617.
7. Johnson, B. 1999. Calibration to dye for: Artel's new pipette calibration system. Scientist 13:14.
8.NCCLS. 1984. Determining Performance of Volumetric Equipment. Proposed guideline 18-P. NCCLS, Villanova, PA.
9. Skeen, G. A.,, and E. R. Ashwood. 2000. Using spectrophotometry to evaluate volumetric devices. Lab. Med. 31:478479.
10. Steiner, P., 1989. Basic laboratory principles and calculations, p. 19. In L. A. Kaplan, and A. J. Pesce (ed.), Clinical Chemistry, 2nd ed. The C. V. Mosby Co., St. Louis, MO.

Tables

Generic image for table
Table 3.12-1

Urinary microbiota

Abbreviations: AST, antimicrobial susceptibility testing; ID, identification; VRE, vancomycin-resistant enterococcus.

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-2

Definitions

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-3

Summary of bacteriological culture systems

Updated from reference . Abbreviations: ID, identification; CLED, cystine lactose electrolyte-deficient agar.

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-4

Protocol for workup of urine cultures

Urogenital or skin microbiota that is at least 10 times less than the uropathogens is ignored for purposes of workup. If this microbiota is equal to the uropathogens, report “Multiple bacterial morphotypes present. Suggest appropriate recollection with timely delivery to the laboratory, if clinically indicated.” For list of uropathogens and urogenital and skin microbiota, see Table 3.12-1 .

For minimal identification (ID), see Table 3.12-5 .

Report any amount of group B streptococci () in this age group. Check staphylococci with novobiocin disk for , a uropathogen in this age group.

For definitive ID, see Table 3.12-1 .

See text (item V.B.5.b) for exceptions.

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-5

Reporting of isolates with minimal testing

See Table 3.12-4 for indications. Abbreviations: KIA, Kligler's iron agar; TSI, triple sugar iron agar; PYR, pyrrolidonyl-β-naphthylamide.

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-A1

Calibration methods for volume-dispensing instruments

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-A2

Commercial pipettor calibration systems and related products

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-A3

Suggested calibration schedule for microbiology laboratory pipettors

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-A4

value for distilled water as a function of temperature and pressure

Adapted from with permission.

1mm Hg = 133.322 Pa.

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-A5

Theoretical absorbance values for test solutions

Adapted from reference with permission

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12
Generic image for table
Table 3.12-A6

Suggested tolerance limits for microbiology pipettors

See Table 3.12-A3 , footnotes and FA, fluorescent antibody.

Includes Venereal Disease Research Laboratory and rapid plasma reagin tests.

Citation: Garcia L. 2010. Urine Cultures, p 410-440. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.12

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