Controversies in the Diagnosis of Urinary Tract Infections

Kubik, Melanie J.; McCarter, Yvette S.

doi:10.1016/j.clinmicnews.2012.11.001

Cited by 12 publications

(11 citation statements)

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“…The studies included in this review reported collection, storage, and preservation of urine samples through commonly used methods for both children and adults in both inpatient and outpatient settings; results are therefore likely to apply to other health care environments. Many of the methods for collection, storage, and preservation are widely recommended ( 18 , 63 ) and are typically used in most hospitals, outpatient clinics, and clinical microbiology laboratories today ( 21 , 22 ). The focus of this review, however, is largely on clean-catch midstream urine collection because this method remains the most commonly used in most patient populations and settings ( 18 ).…”

Section: Additional Considerationsmentioning

confidence: 99%

“…The focus of this review, however, is largely on clean-catch midstream urine collection because this method remains the most commonly used in most patient populations and settings ( 18 ). This is primarily due to its noninvasiveness; i.e., it has no risk of producing iatrogenic infection, despite the paucity of data supporting its use as a standard ( 63 ).…”

Section: Additional Considerationsmentioning

confidence: 99%

“…Controversy remains among clinical microbiologists and infectious disease physicians about the most accurate means for diagnosing urinary tract infections, including the best methods of specimen collection for women, men, children, and infants ( 19 , 63 ). A recent collaboration between the American Society for Microbiology (ASM) and the Infectious Disease Societies of America (IDSA), designed to assist physicians in the appropriate use of laboratory tests for infectious diseases, addressed methods of specimen collection, as well as guidelines for testing patients for urinary tract infections ( 64 ).…”

Section: Additional Considerationsmentioning

confidence: 99%

“…Conversely, the use of high concentrations of boric acid as a preservative has been known to inhibit urinary pathogens such as Escherichia coli and Klebsiella pneumoniae ( 65 ). Midstream urine collection may be the preferred choice for collection for most patients; however, there are patient populations and clinical scenarios where a more invasive method of collection is preferred ( 63 ). All of these issues can produce incorrect culture results, misdiagnosis, especially in asymptomatic patients, poor patient management, including the use of inappropriate or ineffective antibiotics, and potentially more complicated urinary tract infection in the long term ( 2 , 3 ).…”

Section: Additional Considerationsmentioning

confidence: 99%

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Effectiveness of Preanalytic Practices on Contamination and Diagnostic Accuracy of Urine Cultures: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis

LaRocco¹,

et al. 2016

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SUMMARYBackground.Urinary tract infection (UTI) in the United States is the most common bacterial infection, and urine cultures often make up the largest portion of workload for a hospital-based microbiology laboratory. Appropriately managing the factors affecting the preanalytic phase of urine culture contributes significantly to the generation of meaningful culture results that ultimately affect patient diagnosis and management. Urine culture contamination can be reduced with proper techniques for urine collection, preservation, storage, and transport, the major factors affecting the preanalytic phase of urine culture.Objectives.The purposes of this review were to identify and evaluate preanalytic practices associated with urine specimens and to assess their impact on the accuracy of urine culture microbiology. Specific practices included collection methods for men, women, and children; preservation of urine samples in boric acid solutions; and the effect of refrigeration on stored urine. Practice efficacy and effectiveness were measured by two parameters: reduction of urine culture contamination and increased accuracy of patient diagnosis. The CDC Laboratory Medicine Best Practices (LMBP) initiative's systematic review method for assessment of quality improvement (QI) practices was employed. Results were then translated into evidence-based practice guidelines.Search strategy.A search of three electronic bibliographic databases (PubMed, SCOPUS, and CINAHL), as well as hand searching of bibliographies from relevant information sources, for English-language articles published between 1965 and 2014 was conducted.Selection criteria.The search contained the following medical subject headings and key text words: urinary tract infections, UTI, urine/analysis, urine/microbiology, urinalysis, specimen handling, preservation, biological, preservation, boric acid, boric acid/borate, refrigeration, storage, time factors, transportation, transport time, time delay, time factor, timing, urine specimen collection, catheters, indwelling, urinary reservoirs, continent, urinary catheterization, intermittent urethral catheterization, clean voided, midstream, Foley, suprapubic, bacteriological techniques, and microbiological techniques.Main results.Both boric acid and refrigeration adequately preserved urine specimens prior to their processing for up to 24 h. Urine held at room temperature for more than 4 h showed overgrowth of both clinically significant and contaminating microorganisms. The overall strength of this body of evidence, however, was rated as low. For urine specimens collected from women, there was no difference in rates of contamination for midstream urine specimens collected with or without cleansing. The overall strength of this evidence was rated as high. The levels of diagnostic accuracy of midstream urine collection with or without cleansing were similar, although the overall strength of this evidence was rated as low. For urine specimens collected from men, there was a reduction in contamination in favor of mi...

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Section: Additional Considerationsmentioning

confidence: 99%

Section: Additional Considerationsmentioning

confidence: 99%

Section: Additional Considerationsmentioning

confidence: 99%

Section: Additional Considerationsmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of Preanalytic Practices on Contamination and Diagnostic Accuracy of Urine Cultures: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis

LaRocco¹,

et al. 2016

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“…As noted by Stamm and colleagues, for women with acute urethral syndrome, the best diagnostic criterion was Ն10 2 bacteria/ml (8). Kubik and McCarter noted that the recent literature has suggested that lower levels of bacteriuria (10 2 to 10 4 CFU/ml) should be considered positive for urinary tract infections in patients with symptoms of cystitis (9). Utilizing a precise, reproducible 10-l inoculum volume with the BD InoqulA instrument thus increases both test accuracy and sensitivity.…”

mentioning

confidence: 99%

Impact of Introduction of the BD Kiestra InoqulA on Urine Culture Results in a Hospital Clinical Microbiology Laboratory

Strauss

Bourbeau

2015

J Clin Microbiol

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bThis study compared results from plating urine specimens with the BD InoqulA instrument using a 10-l inoculum with results from cultures plated manually with a 1-l loop for comparable 2-month periods. The positivity rates, turnaround times for positive cultures, and BD Phoenix identification and antimicrobial susceptibility test results were comparable for both time periods. We experienced no problems with culture interpretation as the result of moving to the 10-l inoculum.I n contrast to the 1-l urine specimen routinely plated in U.S. and Canadian laboratories, many European labs (1, 2, 3), as well as laboratories in other parts of the world, historically have plated 10-l urine specimens. The BD Kiestra InoqulA (BD Kiestra B.V., Drachten, The Netherlands) utilizes a pipetting device with a disposable pipette that dispenses a minimum volume of 10 l. As a result, routine urine specimens plated with the BD InoqulA generally utilize a 10-l inoculum volume, although volumes up to 100 l can be dispensed if needed for a specific laboratory protocol/application. Urine cultures represent a significant percentage of routine bacteriology cultures in most clinical microbiology laboratories, and consequently, any changes to urine culture protocols merit significant attention. For a laboratory that is transitioning from plating 1 l of urine with a manual loop to 10 l with the BD InoqulA, it would be important to assess any impact(s) that this change might have on culture metrics, including positivity rates, ability to obtain isolated colonies, and time(s) to results. This study, designed to compare urine culture results obtained for a fixed time period prior to the installation of a BD InoqulA when plating for specified urine specimen types, was performed manually using a 1-l loop with a time period post-BD InoqulA installation comparable to that when plating was performed with the BD InoqulA using a 10-l inoculum volume. On the basis of the repeated experiences of European laboratories (1, 2, 3), we hypothesized that we would obtain sufficient isolated colonies with the BD InoqulA 10-l inoculum so as to not adversely affect time to completion of cultures or positivity rates compared to results obtained with a 1-l inoculum volume.All urine specimens for the pre-BD InoqulA installation and post-BD InoqulA installation time periods were plated on MacConkey agar and Trypticase soy agar with 5% sheep blood with incubation of all plates at 35°C to 37°C in 5 to 7% CO 2 . Only cleancatch urine specimens or urine collected from indwelling catheters was included in this study. All cultures were examined the day following inoculation, and cultures with no growth on day 1 were reincubated for one additional day. Cultures were worked up similarly during the preinstallation and postinstallation time periods using standard Reading Hospital microbiology laboratory protocols, with workup performed by the microbiology technologist(s) routinely assigned to the urine bench. As appropriate, for positive results, organism identification and ant...

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Laboratory Diagnosis of Urinary Tract Infections: Guidelines, Challenges, and Innovations

Pezzlo

2014

Clinical Microbiology Newsletter

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Controversies in the Diagnosis of Urinary Tract Infections

Cited by 12 publications

References 50 publications

Effectiveness of Preanalytic Practices on Contamination and Diagnostic Accuracy of Urine Cultures: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis

Effectiveness of Preanalytic Practices on Contamination and Diagnostic Accuracy of Urine Cultures: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis

Impact of Introduction of the BD Kiestra InoqulA on Urine Culture Results in a Hospital Clinical Microbiology Laboratory

Laboratory Diagnosis of Urinary Tract Infections: Guidelines, Challenges, and Innovations

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