Interpretation of urine cultures

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Interpretation of urine cultures

Text of Interpretation of urine cultures

  • INTERPRETATION OF URINE CULTURES CUMITECH GUIDELINES INCORPORATED Dr.T.V.Rao MDDR.T.V.RAO MD 12/15/2011 1
  • PATHOPHYSIOLOGY OF URINARY TRACT INFECTION Uncomplicated urinary tract infection: Bacterial or yeast infection in a structurally and neurologically normal urinary tract Complicated urinary tract infection: Bacterial or yeast infection in a urinary tract with functional or structural abnormalities
  • RISK FACTORS IN COMPLICATED URINARY TRACT INFECTION Indwelling catheters Urinary calculi Neurogenic bladder Prostatic enlargement Uterine prolapse Urologic instrumentation or surgery Renal transplantation Diabetes mellitus
  • URINARY TRACT SPECIMENS First-voided morning urine optimal (generally bacteria have been proliferating in bladder urine for several hours) Midstream urine specimens (initially voided urine contains urethral commensals) Indwelling catheters (freshly placed, urine aspirated by needle inserted into catheter) (Foley catheter tips not acceptable) Straight catheter specimens Suprapubic aspirates (infants or children, recovery of anaerobes) Cystoscopic collection of urine Contamination-free specimen DR.T.V.RAO MD 12/15/2011 4
  • COLLECTION OF URINE SPECIMENS Urine collected in sterile specimen container must be processed within 2 hours, or refrigerated and processed within 24 hours Urine collected in sterile specimen container with borate preservative should be processed within 24 hours (no refrigeration required)DR.T.V.RAO MD 12/15/2011 5
  • PROMPT TRANSPIRATION NEEDED Transport to lab as soon as possible Urine should be cultured within 2 hours or be refrigerated for up to 24 hours Microorganisms grow very rapidly in urine at room temperature This could give a false positive culture resultDR.T.V.RAO MD 12/15/2011 6
  • SPECIMEN INOCULATIONS All cultures processed by Semiquantitative method a loop of standard dimension of approximately known volume is inoculated into selected culture plate In general a loop of SWG 28 with a diameter of 3.26 mm internal diameter which can hold a drop of water or urine 0.004 ml. After inoculation the culture plates are incubated at 370c extending to > 18 hours are read The colony counts are made, as each colony corropsdes to number of viable bacteria per ml of urineDR.T.V.RAO MD 12/15/2011 7
  • INOCULATION OF URINE Inoculation of urine for quantitative culture (colony forming unitscfus) performed with a calibrated 0.001 mL and 0.01 mL plastic or wire loop Sheep blood agar (SBA) utilized for quantitative urine culture With 0.001 ml loop, 1 colony on SBA equivalent to 1,000 cfus per mL of urine With 0.01 ml loop, 1 colony on SBA equivalent to 100 cfus per mL of urine MacConkey agar utilized as selective differential agar for gram-negative bacteria, Colistin nalidixic acid agar as selective agar for gram-positive bacteria, and chocolate agar for fastidious gram-negative bacteria (Haemophilus) DR.T.V.RAO MD 12/15/2011 8
  • COMMON UROPATHOGENS Escherichia coli Other Enterobacteriaceae (Klebsiella, Enterobacter, Proteus, Citrobacter) Pseudomonas aeruginosa Enterococcus Staphylococcus saprophyticus Staphylococcus aureus Streptococcus agalactiae (group B) CandidaDR.T.V.RAO MD 12/15/2011 9
  • UNCOMMON UROPATHOGENS Corynebacterium urealyticum Hemophilus influenzae and H. parainfluenzae Blastomyces dermatitidis Neisseria gonorrhaeae Mycobacterium tuberculosisDR.T.V.RAO MD 12/15/2011 10
  • COUNTING THE COLONIES With 0.001 ml loop, 1 colony on SBA equivalent to 1,000 cfus per mL of urine With 0.01 ml loop, 1 colony on SBA equivalent to 100 cfus per mL of urineDR.T.V.RAO MD 12/15/2011 11
  • INTERPRETATION OF URINE CULTURES: GENERAL GUIDELINES A single species of Enterobacteriaceae recovered at >105 cfus/mL urine: with patients symptomatic for urinary tract infection, 95% probability of true bacteriuriaDR.T.V.RAO MD 12/15/2011 12
  • WHAT IS SIGNIFICANT BACTERIURIA Significant bacteriuria in an asymptomatic patient is 100,000 or more colonies per milliliter of urine from a midstream, clean- catch specimen; yet, a colony count of 200 Escherichia coli per ml may be significant in a midstream male void or catheterized female. About 95% of all positive UTI cultures will produce essentially pure cultures if urine is collected carefully and the media inoculated promptly. DR.T.V.RAO MD 12/15/2011 13
  • WHAT CAN BE A SIGNIFICANT COUNT A single species of Enterobacteriaceae recovered at 104-105 cfus/mL urine: with patients symptomatic for urinary tract infection, 33% probability of true bacteriuriaDR.T.V.RAO MD 12/15/2011 14
  • URINE CULTURES Organisms/ml --- very important!100,000 organisms/ml (Many) Usually indicates an infection Patient most likely will have S&S Most often will be treated with antibiotic appropriate for that organismDR.T.V.RAO MD 12/15/2011 16
  • CUMITECH GUIDELINES FOR INTERPRETATION OF ROUTINE URINE CULTURES One isolate at >104: Full ID and Susceptibility One or two gram- negative isolates at >105 and other isolates at least 10X less: Full ID and Susceptibility ofDR.T.V.RAO MD 12/15/2011 17
  • CUMITECH GUIDELINES FOR INTERPRETATION OF ROUTINE URINE CULTURES1 One isolate at >104: Full ID and Susceptibility One or two gram-negative isolates at >105 and other isolates at least 10X less: Full ID and Susceptibility of gram-negative isolates Other patterns of isolates at >104: Presumptive ID only Ignore mixed urethral flora at 100 CFU/ml 0.001 ml inoculum Sterile or < 1000 CFU/ml OR No growth of > 1000 CFU/mlDR.T.V.RAO MD 12/15/2011 19
  • READING THE CULTURE PLATES A true infection in the absence of prior antibiotic therapy the number of bacteria is likely to be at least 105 or more. Contaminated specimens present with colony counts 10 4 to be considered as presence of Urinary tract infection with the supporting clinical history On some occasions more than one pathogen is isolated but should be processed for all practical purposes eg E.coli along with Streptococcus fecalisOn few occasions even counts 10 3 are proved significant DR.T.V.RAO MD 12/15/2011 20
  • INTERPRETATION OF ENTEROBACTERIACEAE A single species of Enterobacteriaceae recovered at >10 5 cfus/mL urine: with patients symptomatic for urinary tract infection, 95% probability of true bacteriuria A single species of Enterobacteriaceae recovered at 104-105 cfus/mL urine: with patients symptomatic for urinary tract infection, 33% probability of true bacteriuria DR.T.V.RAO MD 12/15/2011 21
  • INTERPRETATION OF ENTEROBACTERIACEAE A single species of Enterobacteriaceae recovered at >10 5 cfus/mL urine: with patients symptomatic for urinary tract infection, 95% probability of true bacteriuria A single species of Enterobacteriaceae recovered at 104-105 cfus/mL urine: with patients symptomatic for urinary tract infection, 33% probability of true bacteriuria DR.T.V.RAO MD 12/15/2011 22