European guidelines for urinalysis: a collaborative document produced by European clinical microbiologists and clinical chemists under ECLM in collaboration with ESCMID

Abstract

Urinalysis is one of the most common examinations in microbiological and chemical laboratories as well as at points of care. In addition to bacterial cultures, the term urinalysis encompasses here most common chemical tests related to diseases of the urinary tract and urine particle counting (urine microscopy).Several existing documents can be consulted for details on the microbiological examination of urine [1][2][3][4][5][6]. While quite a few national guidelines covering aspects of urinalysis have also been published [7-9], there is no general international standard or consensus document applicable for, for example, accreditation or validation of new technology available.Recently, a group chaired by Dr Timo Kouri, Tampere, Finland published the European Guidelines for Urinalysis [10] under the auspices of the European Confederation of Laboratory Medicine (ECLM). The complete text of this supplement is available in electronic form from Taylor & Francis at http:// www.tandf.no/sjcli. These guidelines were prepared together with the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Working Party on Urinalysis, moderated by Dr Vanya Gant, London, UK, to guarantee the quality of the written guidelines from the microbiological point of view. Several experts from most European countries have also contributed to the review of the draft document. An introduction to the project and the recently published paper for clinical chemists is given elsewhere [11]. This paper aims to introduce the guidelines to European clinical microbiologists.The ECLM European Urinalysis Guidelines discuss the complete process of clinical urine analysis. They embrace indications for urinalysis at several stages: diagnostic strategies;

Isolation of Members of the Staphylococcus sciuri Group from Urine and Their Relationship to Urinary Tract Infections

“…From this patient with a complicated UTI, a resistant S. lentus strain was isolated to a quantity of 10 5 CFU/ml, but in mixed culture with Enterococcus faecalis. Since true infection with two species may occur (1,14), it is reasonable to assume that the S. lentus strain could have been the etiologic agent of UTI in this patient. Moreover, the patient responded to antibiotic treatment (amoxicillin-clavulanic acid) that may be effective against both S. lentus and E. faecalis.…”

“…The majority of the patients (62%) had various underlying medical conditions, but none was found to be predominant in the study population. The clinical significance of the isolates was determined according to the criteria proposed by the European guidelines for urinalysis (1,14). Seven (53.8%) of the S. sciuri group isolates were obtained in pure culture, and nine (69.2%) were isolated at a quantity of Ն10 5 CFU/ml.…”

“…One case of symptomatic urinary tract infection and five possible cases of asymptomatic bacteriuria caused by these bacteria were established. It is noteworthy, however, that over 50% of the isolates originated from hospitalized patients.Coagulase-negative staphylococci (CoNS), with the exception of Staphylococcus saprophyticus, are generally considered to be bacteria of doubtful pathogenicity in the urinary tract (1,14). However, a few recent studies proposed that significance of some CoNS species as uropathogens may have been somewhat underestimated (6, 7).…”

“…Coagulase-negative staphylococci (CoNS), with the exception of Staphylococcus saprophyticus, are generally considered to be bacteria of doubtful pathogenicity in the urinary tract (1,14). However, a few recent studies proposed that significance of some CoNS species as uropathogens may have been somewhat underestimated (6,7).…”

Evaluation of Sysmex UF-1000i and Alifax Alfred and HBL in rapid diagnosis of acute urinary tract infections in a hub and spoke setting

“…A sample was considered culture-positive if it contained a pure culture of ≥ 10 5 CFU/ml, and when pure growth or predominant growth of one or two organisms were observed, unless diphteroids or Lactobacillus species were identified. More than two different organisms growing in equal numbers was interpreted as contamination (negative for pathogens) (Aspevall et al, 2001;ECLM, 2000).…”