1. What is bacteriuria? When is it significant?

Bacteriuria is the presence of bacteria present in the urine. This bacteria is not a

result of contamination from the method of collection. Urine in the body is

normally sterile; yet, bacteria may enter the urine stream from different types of

infections. Bacteriuria can be confirmed if a single bacterial species is isolated in

a concentration greater than 100,000 colony forming units per millilitre of urine

in clean-catch midstream urine specimens (one for men, two consecutive

specimens with the same bacterium for women).

2. How do microorganisms enter the urinary tract?

The bladder can pick up dangerous normal bacteria and pathogens as they exit

through the urethra. Bacteria in the urine, especially gram-negative rods, usually

indicate a urinary tract infection (either cystitis or pyelonephritis), although

bacteriuria can also occur in prostatitis. Escherichia coli is the most common

bacterium isolated from urine samples.

3. Why is aseptic urine collection important when cultures are ordered?

It is always crucial to use aseptic technique to avoid introducing bacteria to a

urine sample that may otherwise interfere with the collection for testing.
4. List five bacteria that can cause urinary tract infection.

a. Escheria coli

b. Staphylococcus saprophyticus

c. Chlamydia

d. Mycoplasma

e. Pseudomonas aeruginosa

f. Klebsiella pneumoniae

5. If you counted 20 colonies from a 0.01-ml inoculum of a 1:10 dilution of

urine, how many organisms per milliliter of specimen would you report? Is

this number significant?

The inoculum is considered first which would be 20 X 100 / ml or 2000 / ml.

Since you have diluted it again the concentration is higher by a factor of 10 or 10

X 2000 / ml = 20,000 / ml. Urine is not expected to be aseptic; however, it must

be completely free of high-virulence microbial pathogens, and the total number

of aerobic microorganisms per gram must be low.

6. Is the urine colony count an appropriate indicator of the need for an

antimicrobial susceptibility test of an organism isolated from a urine

culture? Why?
Yes, because generally urine itself is basically sterile when it is in the bladder but

when it passes through the tract to outside it picks up bacteria on the way. If

there is an infection in the urinary tract it will show up on urine analysis.

Generally there are some white blood cells in a normal urine sample but those

are usually only 4-6 cells. Once the count goes up, it determines a bacterial

infection. The sample with a positive culture is tested in the laboratory with all

the drugs currently available for sensitivity. The bacterial colony is cultured in

the laboratory and the drug that specifically responds by killing the colony is

marked "sensitive" and the drugs that give no response to the colony are said to

be "resistant". The doctor checks the sensitivity of the culture and subsequently

prescribes the drug that responds to the bacteria present.

7. If you took a urine specimen for culture to the laboratory but found it

temporarily closed, what would you do?

The patient could keep the specimen refrigerated until the laboratory reopens at

the next available time. The patient can store urine samples at 4°C with or

without preservative, and try to get it to the laboratory within 24 hours to

minimize the amount of significant culture result differences. In lieu of that

method, the patient could use a containment system as detailed din the next

question, if one were available.

 8. How would you instruct a female patient to collect her own urine

specimen by the “clean-catch” technique? A male patient?

For female patients, follow the following instructions:

1. Wash your hands.

2.Thoroughly wash between your legs with a washcloth and soapy water. Rinse well

with the washcloth moistened with clean water. Dry gently with a towel.

3.Gently separate the folds over the urinary opening. Repeat the washing process

again and be sure to stroke from front to back when washing.

4.Rinse in the same way.

5. Get the urine collection container. (Do not touch the inside of the container or the

lid.)

6. Start urinating into the toilet. Then hold the container under the stream of urine

and collect at least 1 ounce of urine (30 mL) (See the lines marked on the side of the

container.) Remove the cup from the stream of urine and thenchild finish urinating

into the toilet.

7. Put the cap on the container. Be sure the cap is tightly closed to prevent leaks.

Wash the outside of the container. Remove the rubber gloves and wash your hands

well.
For a male patient:

a. Wipe head of penis in a single motion with first towelette. Repeat with second

towelette. If not circumcised, hold foreskin back before cleansing.

b. Urinate a small amount into toilet.

c. Without stopping flow, collect urine into cup.

d. Finish voiding into toilet.

e. Replace cap tightly on cup, making sure not to touch inside of rim of cup.

(Nationwide Children’s Hospital, 2000)

9. What can you learn from visual inspection of a urine specimen?

A visual inspection of the urine will tell you if the urine is cloudy or clear. A

cloudy specimen may indicate an infection or other substances in the urine. The

color of the urine gives a simple indication of the concentration of the solutes

present. The urine color should be recorded. Abnormal colors are often due to

medications, foods, or dyes, although blood may make the urine red, and

brownish urine may be due to bile pigments. Gross blood may also be seen. The

odor of a specimen should be noted. Certain diseases are associated with

characteristic odors. Ketonuria produces a recognizable smell, heavily infected

specimens are associated with an ammonia smell, and the urine of patients with

advanced liver disease may have a pungent aromatic smell (Young, 2000).

10. Describe a urine transport system that allows the specimen to remain

at room temperature for short time periods without refrigeration.

The FLORA-STAT Urine Transport System (Wadley Biosciences

Corp./Lymphokine Partners Ltd., Dallas, Tex.) was evaluated for its efficacy in

maintaining organism count and in effectively blocking the bactericidal action of

therapeutic antimicrobial agents in urine samples when the urine samples were

held at room temperature (Dorn, 1991). This system may be helpful if

refrigeration is not immediately available.

11. What is leukocyte esterase? What is its significance when detected in

urine?

Leukocyte esterase (LE) is a urine test to look for white blood cells and other

signs associated with infection. An abnormal result (presence of LE) indicates a

possible urinary tract infection.