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Urine Cultures - Interpretation

Clinical Laboratory Science Program
Carol Larson MSEd, MT(ASCP Edited!
M" #urgensmeier MT (ASCPSM
Interpretation o$ Urine Culture
% A$ter &' (ours o$ incubation, t(e culture
plates are e)aluated $or gro*t(
+,
% -emember. +,-/,0 o$ urine cultures
recei)ed in t(e laboratory *ill be 12o
gro*t(3 or 1gro*t( o$ contaminants only3
CLS 455 Medical Microbiology
Unit 56 Urine Culture Interpretation
1
Interpretation o$ Urine Culture
% 7ou must determine *(at gro*t( (i$ any is
signi$icant (potential pat(ogen and *(at is
contamination
8 Points to 9eep in mind!
8 Type o$ urine collection met(od used
8 Patient clinical (istory (i$ a)ailable
8 2ormal periuret(ral $lora (contaminants
8 Colony count guidelines
A$ter &' :ours o$ Incubation
% 2o gro*t( on eit(er plate
8 -eincubate plates $or an additional &' (ours
in case t(ere is an organism t(at gro*s more
slo*ly
% ;isible gro*t( on plate(s
8 E)aluate t(e gro*t(
Colony Count Interpretation
% I$ t(e calibrated loop
used *as ,",5 ml
t(en eac( colony
e<uals 5,, c$u
8 E=ample!
5> colonies seen =
5,, ? 5,>,, c$u@ml
Colony Count Interpretation
A2eed pic o$ 54 colonies o$ E" coli on a Mac plate 8 colony countB
% I$ t(e calibrated loop
used *as ,",,5 ml
t(en eac( colony
e<uals 5,,, c$u
8 E=ample!
5> colonies seen =
5,,, ? 5>,,,, c$u@ml
CLS 455 Medical Microbiology
Unit 56 Urine Culture Interpretation
2
Colony Count Interpretation
% I$ t(e number o$ colonies o$ one colony type is more
t(an 5,,,,,,, t(en report out colony count as
C5,,,,,, c$u@ml
% Con$luent gro*t( o$ bacteria, co)ering most o$ t(e
inoculated sur$ace area o$ t(e plates can be read as
C5,, ,,, c$u@ml
C5,,,,,, c$u@ml"
Colony Count Interpretation
% I$ t(ere is no gro*t( on t(e plate t(en
report out!
8 Using ,",5 loop! D5,, c$u@ml, 2o gro*t(
Using , ,,5 loop! D5,,, c$u@ml 2o gro*t(
8 Using ,",,5 loop! D5,,, c$u@ml, 2o gro*t(
Colony Count Interpretation
% Colony count guidelines are used to aid
in t(e interpretation o$ a urine culture
pro)ided on t(e ne=t
% An e=ample o$ t(ese guidelines are
pro)ided on t(e ne=t slide
Colony Count Euidelines
Re
sul
t
Specimen type /
Clinical
condition, if
Wor
kup
'
pat(ogen, or $or
eac( o$ & potential
pat(ogens
Clean-catc( midstream
urine @ pyelonep(ritis,
acute cystitis,
asymptomatic
bacteriuriaF
Complete 8 identi$ication
o$ t(e organism and
appropriate susceptibility
testing
C5,
>
c$u@ml o$ a single
potential pat(ogen
Clean-catc( midstream
urine @
symptomatic males
OR cat(eteriGed urine
OR acute uret(ral
Complete 8 identi$ication
o$ t(e organism and
appropriate susceptibility
testing
C > organism types
*it( no predominating
organism
Clean-catc( midstream
urine
OR cat(eteriGed urine
2one" Hecause o$
possible contamination,
as9 $or anot(er
specimen
Eit(er & or > organism
types *it( predominant
gro*t( o$ one organism
type and D5,
'
c$u@ml o$
t(e ot(er organism
Clean-catc( midstream
urine
Complete *or9up $or
t(e predominating
organism(sF
description o$ t(e
ot(er organism(s
C5,, c$u@ml o$ any
number o$ organism
types (set up *it( a
,",,5 and ,",5 ml
calibrated loop
Suprapubic aspirates, any
ot(er surgically obtained
urines (including ileal
conduits, cystoscopy
specimens
Complete 8
identi$ication o$
organism and
appropriate
susceptibility testing
C5, c$u@ml o$ single potential
Eeneral Considerations
% C5,,,,,, c$u@ml is indicati)e o$ a UTI,
e=cept *(en t(e isolate is a
contaminant
% 5,,,,, 8 5,,,,,, c$u@ml may indicate
in$ection, especially i$ only one colony
type is gro*ing
Eeneral Considerations
% D5,,,,, c$u@ml is not *or9ed up *(en
contaminants are present
P i t $ t( i
% Persistence o$ t(e same organism on
repeat urine cultures *ill increase t(e
li9eli(ood t(at it is a pat(ogen e)en i$ t(e
colony counts are lo*
8 i"e" D5,,,,, c$u@ml
-emember.
% I(en t(ere is gro*t( o$ t(ree or more
di$$erent organisms, consider t(e
specimen contaminated and *or9-ups
are not done
Ior9up o$ Signi$icant Ero*t(
% Culture plates are ree)aluated at '/ (ours
and any ne* and@or additional in$ormation
is *or9ed up and reported
-eporting -esults
% I$ culture (as no gro*t(, report!
8 T(e colony count as!
% D5,,, c$u@ml (i$ ,",,5 loop used
% D5,, c$u@ml (i$ ,",5 loop used
% And 12o gro*t( at &' (ours3
% Jr 12o gro*t( at '/ (ours3
pat(ogen or $or eac( o$ &
organism and appropriate
Resul
t
Specimen
C5,
'
c$u@ml o$ single
potential pat(ogen, or $or
eac( o$ & potential
pat(ogens
Clean-catc(
urine
cystiti
bacteriuriaF
OR
C5,
>
c$u@ml o$ a single
potential pat(ogen
Clean-catc(
symptomatic
OR
OR
C > organism types *it(
no predominating
organism
Clean-catc(
OR
Eit(er & or > organism types
*it( predominant gro*t( o$
one organism type and D5,
'
c$u@ml o$ t(e ot(er organism
types(s
Clean-catc(
C5,, c$u@ml o$ any number
o$ organism types (set up
*it( a
Suprapubic
ot(er surgically
urines (including
loop cystoscopy
Colony
Count Euidelines
>10.000 cfu/ml dengan 1-2 jenis bakteri potensial patogen maka pemeriksaan dilanjutkan dengan identifikasi jenis bakteri tersebut.
>1000 cfu/ml dengan 1 jenis bakteri potensial patogen, maka pemeriksaan dilanjutkan dengan identifikasi jenis bakteri tersebut.
≥ 3 jenis tipe organisme tanpa mikroorganisme predominan dianggap terkontaminasi dan dianjurkan untuk mengulang kultur.
>100 cfu/ml dengan mikroorganisme jenis apa saja dan dengan sediaan urin yang berasal dari aspirasi suprapubik maka dilanjutkan dengan identifikasi jenis organisme.
>10

cfu/ml of single potential
pat!ogen, or for eac! of 2
potential pat!ogens
"lean-catc! midstream urine /
pyelonep!ritis, acute cystitis,
asymptomatic bacteriuria#
OR cat!eteri$ed urine
"omplete % identification of t!e
organism and appropriate
susceptibility testing
>10
3
cfu/ml of a single potential
pat!ogen
"lean-catc! midstream urine /
symptomatic males
OR cat!eteri$ed urine
OR acute uret!ral syndrome
"omplete % identification of t!e
organism and appropriate
susceptibility testing
> 3 organism types &it! no
predominating organism
"lean-catc! midstream urine
OR cat!eteri$ed urine
'one. (ecause of possible
contamination, ask for anot!er
specimen
)it!er 2 or 3 organism types
&it! predominant gro&t! of one
organism type and *10

cfu/ml
of t!e ot!er organism types+s,
"lean-catc! midstream urine "omplete &orkup for t!e
predominating organism+s,#
description of t!e ot!er
organism+s,
>100 cfu/ml of any number of
organism types +set up &it! a
0.001 and 0.01 ml calibrated
-uprapubic aspirates, any ot!er
surgically obtained urines
+including ileal conduits,
"omplete % identification of
organism and appropriate
susceptibility testing
loop cystoscopy specimens