Routine Urine Culture

Aim of the test

Catheterizing the Urinary Bladder for Collection
⮚ An etiological diagnosis of bacterial urinary tract infection by semi
quantitative cultivation of the urine with identification and
⮚ Another method is the catheterized urine specimen in which a
susceptibility test of the isolated bacteria(s).
lubricated catheter (thin rubber tube) is inserted through the
urethra (tube-like structure in which urine is expelled from the
Types of specimen
bladder) into the bladder. This avoids contamination from the
urethra or external genitalia.
⮚ Urine (Midstream urine), suprapubic aspiration, catheterized
urine
▪ Note: First morning specimens yield highest bacterial
counts from overnight incubation in the bladder, and
are the best specimens.

Criteria of specimen rejection

⮚ Un-refrigerated specimen older than 2 hours may be subject to

overgrowth and may not yield valid results, unlabeled specimen,
Preservation and Storage mislabeled specimen, and specimen is expired transport
Changes that affect Refrigeration- most container, 24 hours urine specimens.
the chemical or common method for
Pathogens and commensals
microscopic storing and
properties of urine is preserving urine
kept at room -It prevents bacterial
temperature for more growth for 24 hours
than 1 hour -After 24 hours use
chemical

Specimen Collection and Transport Guidelines

⮚ All urine collection and/or transport containers should be clean

and free of particles or interfering substances
⮚ The collection and/or transport container should have a secure lid
and be leak-resistant. Leak-resistant containers reduce specimen
loss and healthcare worker exposure to the specimen while also
protecting the specimen form containers

Urine Specimen Handling Guidelines

⮚ Labels include the patient name and identification on labels.

Make sure that the information on the container label and the
requisition match. If the collection container is used for transport,
Pre specimen processing
the label should be placed on the container and not on the lid,
since the lid can be mistakenly placed on a different container.
Patient preparing
Ensure that the labels used on the containers are adherent under
refrigerated conditions. ⮚ Instruct the procedures for the patient Specimen collection
⮚ Collection Date and Time includes collection time and date on the ⮚ Collection of midstream urine for bacterial investigation:
specimen label. This will confirm that the collection was done ⮚ Patient not needing assistance:
correctly. For timed specimens, verify start and stop times of ⮚ Give the patient a suitable container.
collection. Document the time at which the specimen was ⮚ Instruct the patient before the collection, preferably with
received in the laboratory for verification of proper handling and illustration.
transport after collection ⮚ Tell the patient not to touch the inside or rim of the container

Prompt transportation needed Who will collect the specimen?

⮚ Transport to lab ASAP ⮚ Midstream urine is collected by the patient

⮚ Urine should be within 2 hours or be refrigerated for up to 24 ⮚ If disabled, nursing staff will assistant in collection
hours ⮚ For catheterized specimen, nursing staff will collect the specimen
⮚ Microorganisms grow very rapidly in urine at room temperature ⮚ Suprapubic aspiration is performed by the physician
⮚ This could give a false positive culture result
Quantity of specimens ⮚ Dip a 1 μl or 10 μl calibrated loop in vertical position in the urine
and remove the loop and use the collected fluid to inoculate
⮚ To fill line in transport tube (-20ml) Nutrient, Blood and MacConkey agars respectively.

Time relapse before processing the sample

⮚ The maximum time allowed for processing a urine sample is 2

hours from the time of collection

Storage

⮚ At room temperature unless delay is inevitable; it must be

refrigerated or mixed with preservative like boric acid Colony Counting

Specimen Processing ⮚ CFU/ml In original sample = # colonies counted/ (Dilution)

URINE
(Volume plated in mL)
WET MOUNT GRAM STAIN ⮚ A plate count of 100,000 CFU/ml of pure culture should be
considered positive and isolated organism should be identified
and sensitivity test will be performed.
MACCONKEY AGAR NUTRIENT AGAR
⮚ A plate count between 10,000-100,000 CFU/ml is considered
BLOOD AGAR
suspected
⮚ A plate count between less than 10,000 CFU/ml is considered
negative.
URINE
Initial report
WET MOUNT Post specimen processing
⮚ The use of dipstick designed to detect the presence of urine
nitrite and to indirectly estimate the number of segmented Interfering factors
neutrophiles through the detection of leukocyte esterase activity.
Rationale for the nitrate test I tat most urinary tract infections are ⮚ Patient on antibiotic therapy
caused by nitrate reducing members of the family ⮚ Improper sample collection
Enterobacteriaceae.
⮚ Leukocyte Esterase (LE) is produced by segmented neutrophiles; Result reporting
this test when perfomed alone correlated with ten or more white
⮚ Report wet amount as an initial report
blood cells per high power field in the urine equates with a
⮚ Report the isolated pathogen and its sensitivity pattern as a final
sensitivity in the range 88% and specificity 94%
report
Screening Test
URINE Turn around time

GRAM STAIN
⮚ Wet mount results should be available 1 hour after specimen
⮚ As many as 60% to 80% of all urine specimens received for culture report
by the acute care medical center laboratory may contain no ⮚ Isolation of a possible pathogen can be expected after 2-3 days
etiological agents of infection. Procedure developed to identify ⮚ Negative culture will be reported out 1-2 days after the receipt of
quickly those urine specimens that will be negative on culture, the specimen
thus to circumvent excessive use of media, technologist time, and
Additional Information
the overnight incubation period. The gram stain is the easiest,
least expensive, and probably the most sensitive and reliable
⮚ A single culture is about 80% accurate in the female, two
screening method for identifying urine specimen that contain
containing the same organism with count of 10’5 or more
greater that 105 CFU/ml
represents 95% chance of true bacteriuria., three such specimens
▪ A drop of well-mixed in urine is allowed to air dry
mean virtual certainty of true bacteriuria.
▪ The smear Is stained and examined under of
⮚ Single clean voided specimen from an adult made may be
immersion (1000X)
considered diagnostic with proper preparation and care in
▪ Presence of at least one organism per oil immersion
specimen collection
field (examining 20 fields) correlates with significant
⮚ UTI is significantly higher in woman who use diaphragm
bacteriuria (> 105 CFU/ml)
spermicide contraception, perhaps secondary to increased vaginal
pH and a higher frequency of vaginal colonization with E.coli
URINE
⮚ Most laboratories limit the number of organisms which will be
identified when recovered from urine to two.
⮚ If the patient is receiving antimicrobial therapy at the time the
BLOOD AGAR MACCONKEY AGAR NUTRIENT AGAR
specimen is collected, any level of bacteriuria may be significant
⮚ Failure to recover aerobic organisms from patients with pyuria or
Culturing Procedure positive Gram’s stains of urinary sediment may indicate the
presence of mycobacteria or anaerobes.
⮚ Mix the urine sample to re-suspend microorganism present.