Performance of Urinalysis Parameters in Predicting Urinary Tract Infection: Does One Size Fit all?

In a multi-hospital cohort study of 3392 patients, positive urinalysis parameters had poor positive predictive value for diagnosing urinary tract infection (UTI). Combined urinalysis parameters (pyuria or nitrite) performed better than pyuria alone for ruling out UTI. However, performance of all urinalysis parameters was poor in older women.

Contaminant Organism Growth in Febrile Infants at Low Risk for Invasive Bacterial Infection.

In this multicenter, cross-sectional, secondary analysis of 4042 low-risk febrile infants, nearly 10% had a contaminated culture obtained during their evaluation (4.9% of blood cultures, 5.0% of urine cultures, and 1.8% of cerebrospinal fluid cultures). Our findings have important implications for improving sterile technique and reducing unnecessary cultures.

The impact of Boric Acid tubes on quantitative urinary bacterial cultures in hospitalized patients.

INTRODUCTION: The accuracy of urine culture results can be affected by pre-analytical factors such as transport delays and storage conditions. The objectives of this study were to analyze urine collection practices and assess the impact of introducing boric acid tubes for urine collection on quantitative urinary bacterial cultures of hospitalized patients in medical wards. METHODS: A quasi-experimental pre-post study conducted in an acute care facility. In the pre-intervention phase (2020-2021), urine samples were transported without preservatives at room temperature. In 2022 (post-intervention), we transitioned to boric acid transport tubes, evaluating its effect on significant bacterial growth (≥ 105 CFU/ml). Bivariate and multivariate analyses identified predictors of culture positivity. RESULTS: Throughout the duration of the study, a total of 12,660 urine cultures were analyzed. Date and time documentation was complete for 38.3% of specimens. Culture positivity was higher with longer processing times: positivity was 21.3% (220/1034) when specimens were processed within 4 h, 28.4% (955/3364) when processed in 4-24 h, and 32.9% (137/417) when processed after 24 h (p < 0.0001). For 4-24-hour processing, positivity decreased from 30.4% (704/2317) pre-intervention to 24.0% (251/1047) post-intervention (p < 0.001), with no significant changes in < 4 or ≥ 24-hour specimens. Stratified analysis by processing time revealed that the intervention was associated with reduced positivity only in cultures processed within 4-24 h (OR 0.80, 95% CI 0.67-0.94; p = 0.008). CONCLUSION: The introduction of boric acid transport tubes predominantly influenced cultures transported within a 4-24-hour window. This presents an opportunity to improve urine tract infection diagnostic practices in healthcare settings.

Diagnostic Stewardship for Urine Cultures.

Urinary tract infections are among the most common infectious diagnoses in health care, but most urinary tract infections are diagnosed inappropriately in patients without signs or symptoms of infection. Asymptomatic bacteriuria leads to inappropriate antibiotic prescribing and negative downstream effects, including antimicrobial resistance, health care-associated infections, and adverse drug events. Diagnostic stewardship is the process of modifying the ordering, performing, or reporting of test results to improve clinical care. Diagnostic stewardship impacts the diagnostic pathway to decrease inappropriate detection and treatment of asymptomatic bacteriuria. This article reviews diagnostic stewardship methods and closes with a case study illustrating these principles in practice.

Bacterial species cultured after electrofulguration in women with a history of antibiotic-recalcitrant urinary tract infections frequently compare with pre-fulguration findings: a pilot study.

Electrofulguration (EF) of areas of chronic cystitis in women with antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) can result in improvement of their urinary tract infections (UTIs). We compared urine culture (UC) findings in patients before and after EF, as well as how they vary with cystitis stage at the time of EF, to evaluate for persistent species. After obtaining institutional review board approval, we retrospectively reviewed a prospectively maintained database of EF patients for those with positive UC findings in the 3-6 months preceding EF. Patient pre-EF UC was then compared with first positive UC after EF prompted by a new symptomatic UTI episode, with the hypothesis that the same species will be identified before and after EF. Exclusion criteria included UC from outside institution, neurogenic bladder, and need for catheterization. Ninety-nine women with pre- or post-EF UC-recorded organisms met the study criteria. The median age was 65 years (interquartile range 64-74), with a median time to first positive culture following fulguration of 9.7 months. For 26 patients with positive cultures both pre- and post-EF, the same organism was present in both cultures in 73% of the patients, with predominantly Escherichia coli. EF was effective at reducing the rate of UTIs in this population. For women undergoing EF for antibiotic-recalcitrant RUTIs and associated chronic cystitis lesions, 73% of those with a UC obtained at the time of a first symptomatic recurrent UTI episode post-EF expressed the same organism as before EF. Further study is needed to better understand the evolution of the microbiome post-EF.IMPORTANCEAmong women who experience a recurrent urinary tract infection after a fulguration procedure on areas of chronic cystitis in their bladder, there are no data available on whether the bacterial species found in urine cultures are the same or different from those present before fulguration. By removing the inflamed surface layer of cystitis during fulguration, it is possible that the procedure unmasks deep-seated bacteria. The bacterial kingdom in the bladder wall of these chronically infected women may be different from what is expressed sporadically in urine cultures. Confirming prior studies, we found that fulguration in women with antibiotic-recalcitrant recurrent urinary tract infections and cystitis lesions was effective at reducing the rate of urinary tract infections. At the time of a first symptomatic recurrent UTI episode post-fulguration, 73% expressed the same organism in urine culture as before fulguration. Further study is needed to better understand the evolution of the microbiome post-EF. This article evaluates persistent infections after electrofulguration of areas with chronic cystitis in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Pre-fulguration urine cultures were compared with the first positive urine culture prompted by a new symptomatic UTI episode after electrofulguration, with the hypothesis that the same species will be identified before and after the fulguration procedure. Electrofulguration was effective at reducing the rate of UTIs in this population. However, 73% of those with a urine culture obtained at the time of a first symptomatic recurrent UTI episode post-electrofulguration expressed the same organism (predominantly Escherichia coli) as before the fulguration procedure. Further study is needed to better understand the evolution of the microbiome after electrofulguration.

The Impact of Laboratory Automation on the Time to Urine Microbiological Results: A Five-Year Retrospective Study.

Total laboratory automation (TLA) is a valuable component of microbiology laboratories and a growing number of publications suggest the potential impact of automation in terms of analysis standardization, streaking quality, and the turnaround time (TAT). The aim of this project was to perform a detailed investigation of the impact of TLA on the workflow of commonly treated specimens such as urine. This is a retrospective observational study comparing two time periods (pre TLA versus post TLA) for urine specimen culture processing. A total of 35,864 urine specimens were plated during the pre-TLA period and 47,283 were plated during the post-TLA period. The median time from streaking to identification decreased from 22.3 h pre TLA to 21.4 h post TLA (p < 0.001), and the median time from streaking to final validation of the report decreased from 24.3 h pre TLA to 23 h post TLA (p < 0.001). Further analysis revealed that the observed differences in TAT were mainly driven by the contaminated and positive samples. Our findings demonstrate that TLA has the potential to decrease turnaround times of samples in a laboratory. Nevertheless, changes in laboratory workflow (such as extended opening hours for plate reading and antibiotic susceptibility testing or decreased incubation times) might further maximize the efficiency of TLA and optimize TATs.

Selection of Unnecessary Urine Culture Specimens Using Sysmex UF-5000 Urine Flow Cytometer / 대한임상미생물학회지

BACKGROUND: Urine culture is one of the most frequently requested tests in microbiology. Automated urine analyzers yield much infection-related information. The Sysmex UF-5000 analyzer (Sysmex, Japan) is a new flow cytometry urine analyzer capable of quantifying urinary particles, including bacteria, WBCs, and yeast-like cells (YLCs) and can provide a Gram stainability flag. In this work, we evaluated how many unnecessary urine cultures could be screened out using the UF-5000. METHODS: We compared the culture results of 126 urine samples among 453 requested urine cultures (from sources other than the Urology and Nephrology departments) with urinalysis results. Urine cultures were considered positive if bacterial or YLC growth was ≥104 CFUs/mL. RESULTS: We used urinalysis cut-off values of 50/µL and 100/µL for bacteria and YLC, respectively. Forty eight of the 126 (38.1%, or 10.6% of 453 requested) cultures were below these cut-off values and did not contain any culture-positive samples. CONCLUSION: Bacteria and YLC counts generated using the UF-5000 analyzer could be used to screen out negative cultures and reduce urine culture volume by ~10% without sacrificing detection of positive cultures.

Multicenter Evaluation of an Image Analysis Device (APAS): Comparison Between Digital Image and Traditional Plate Reading Using Urine Cultures

BACKGROUND: The application of image analysis technologies for the interpretation of microbiological cultures is evolving rapidly. The primary aim of this study was to establish whether the image analysis system named Automated Plate Assessment System (APAS; LBT Innovations Ltd., Australia) could be applied to screen urine cultures. A secondary aim was to evaluate differences between traditional plate reading (TPR) and the reading of cultures from images, or digital plate reading (DPR). METHODS: A total of 9,224 urine samples submitted for culture to three clinical laboratories, two in Australia and one in the USA, were included in the study. Cultures were prepared on sheep blood and MacConkey agar plates and read by panels of three microbiologists. The plates were then presented to APAS for image capture and analysis, and the images and results were stored for later review. RESULTS: Image analysis of cultures using APAS produced a diagnostic sensitivity and specificity of 99.0% and 84.5%, respectively. Colonies were detected by APAS on 99.0% of blood agar plates with growth and on 99.5% of MacConkey agar plates. DPR agreed with TPR for colony enumeration on 92.1% of the plates, with a sensitivity of 90.8% and specificity of 92.8% for case designation. However, several differences in the classification of colony morphologies using DPR were identified. CONCLUSIONS: APAS was shown to be a reliable screening system for urine cultures. The study also showed acceptable concordance between DPR and TPR for colony detection, enumeration, and case designation.

Search of leptospires and of antibodies against leptospires in animals and human beings in farms in Pantanal and Caatinga Brazilian biomes / Pesquisa de leptospiras e de anticorpos contra leptospiras em animais e humanos de propriedades rurais nos biomas brasileiros Pantanal e Caatinga

The occurrence of Leptospira and of seroreactivity against Leptospira was investigated in animals and humans from six farms located in two Brazilian biomes that have different geoclimatic conditions: Pantanal municipalities of Miranda (MS), Itiquira (MT) and Pocone (MT) and Caatinga municipalities of Sobradinho (BA), Garanhuns (PE) and Sobral (BA). Blood and urine samples of wildlife, domestic animals and humans were collected at each property. The samples were collected from February to April 2012 in Caatinga and from July to September 2012 in Pantanal. The serological reactivity against Leptospira spp. was verified by microscopic agglutination technique (MAT) made with a collection consisting by 24 antigens of Leptospira spp. The leptospires research was carried out by urine samples crop sown in Fletcher resources and Ellinghausen McCullough Johnson Harris (EMJH). Crops with growth of leptospires were referred to the Leptospirosis Laboratory of the Institute of Pathobiology, National Institute of Agricultural Technology, Buenos Aires, Argentina and isolated Leptospira strains were genotyped with the technique of Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). The classification procedure employed the VNTR 4, 7, 9, 10, 19, 23, 31, LB4 and LB5, which discriminate strains of L. interrogans and L. borgpetersenii. In Pantanal, 17 wildlife, 65 domestic animals and two humans were examined. In Caatinga, seven wild animals were examined, along with 100 domestic animals and 26 humans. Of 84 blood samples tested in Pantanal, 47 (55.95%) were positive and, of 133 in Caatinga, 59 (44.36%) were reactant. By Fishers exact test, considering a 0.05 significance level, there was no difference between the proportions of serum reagent animals against Leptospira spp. in two biome reviews (p = 0.063). The predominant serovars in SAM reactions were: 1) Pantanal Bratislava (wildlife, dogs and humans), Grippotyphosa (horses and cattle); 2) Caatinga Copenhageni (humans and dogs), Patoc (horses and cattle), Panama (sheep and goats), Patoc, Copenhageni and Australis (wildlife). Four strains of Leptospira were isolated: two in Sobradinho, BA, L. interrogans serogroup Pomona in Cavea aperea and L. interrogans in Euphractus sexcinctus; and two in Sobral, CE, L. interrogans in Cerdocyon thous and L. interrogans serogroup Pomona in Euphractus sexcinctus.(AU)

Foi investigada a ocorrência de leptospiras e de sororreatividade para leptospiras em animais e seres humanos de seis propriedades rurais localizadas em dois biomas brasileiros que apresentam condições geoclimáticas distintas: Pantanal municípios de Miranda (MS), Itiquira (MT) e Poconé (MT) e Caatinga municípios de Sobradinho (CE), Garanhuns (PE) e Sobral (BA). Em cada uma das propriedades, foram realizadas colheitas de sangue e de urina de animais selvagens de vida livre, animais domésticos e de seres humanos. As colheitas de materiais foram realizadas no período de fevereiro a abril de 2012 no bioma Caatinga e no período de julho a setembro de 2012 no bioma Pantanal. A reatividade sorológica contra Leptospira spp. foi verificada pela técnica de soroaglutinação microscópica (SAM) efetuada com uma coleção de antígenos constituída por 24 sorovares de Leptospira spp. A pesquisa de leptospiras foi efetuada por cultivos de amostras de urina semeadas nos meios Fletcher e de Ellinghausen McCullough Johnson Harris (EMJH). Os cultivos em que houve crescimento de leptospiras foram encaminhados ao Laboratório de Leptospirose do Instituto de Patobiologia, Instituto Nacional de Tecnologia Agropecuária, Buenos Aires, Argentina e as estirpes de leptospiras isoladas foram genotipadas com o emprego da técnica de Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). O procedimento de tipificação empregou os VNTR 4, 7, 9, 10, 19, 23, 31, Lb4 e Lb5, que discriminam estirpes de L. interrogans e L. borgpetersenii. No Pantanal, foram examinados 17 animais selvagens, 65 animais domésticos e dois humanos. Na Caatinga, foram examinados sete animais selvagens, 100 animais domésticos e 26 humanos. Das 84 amostras de sangue examinadas no Pantanal, 47 (55,95%) foram reagentes e, das 133 da Caatinga, 59 (44,36%) foram reagentes. Pelo teste exato de Fisher, considerando-se um nível de significância de 0,05, não houve diferença entre as proporções de animais sororreagentes para Leptospira spp. nos dois biomas avaliados (p = 0,063). Os sorovares predominantes nas reações de SAM foram: 1) Pantanal Bratislava (animais selvagens, cães e humanos); Grippotyphosa (equinos e bovinos); 2) Caatinga Copenhageni (humanos e cães), Patoc (equinos e bovinos), Panama (ovinos e caprinos), Patoc, Copenhageni e Australis (animais selvagens). Houve isolamento de quatro estirpes de leptospiras: duas em Sobradinho, BA, L. interrogans sorogrupo Pomona em Cavea aperea e L. interrogans em Euphractus sexcinctus; e duas em Sobral, CE, L. interrogans em Cerdocyon thous e L. interrogans sorogrupo Pomona em Euphractus sexcinctus.(AU)

Search of leptospires and of antibodies against leptospires in animals and human beings in farms in Pantanal and Caatinga Brazilian biomes / Pesquisa de leptospiras e de anticorpos contra leptospiras em animais e humanos de propriedades rurais nos biomas brasileiros Pantanal e Caatinga

The occurrence of Leptospira and of seroreactivity against Leptospira was investigated in animals and humans from six farms located in two Brazilian biomes that have different geoclimatic conditions: Pantanal municipalities of Miranda (MS), Itiquira (MT) and Pocone (MT) and Caatinga municipalities of Sobradinho (BA), Garanhuns (PE) and Sobral (BA). Blood and urine samples of wildlife, domestic animals and humans were collected at each property. The samples were collected from February to April 2012 in Caatinga and from July to September 2012 in Pantanal. The serological reactivity against Leptospira spp. was verified by microscopic agglutination technique (MAT) made with a collection consisting by 24 antigens of Leptospira spp. The leptospires research was carried out by urine samples crop sown in Fletcher resources and Ellinghausen McCullough Johnson Harris (EMJH). Crops with growth of leptospires were referred to the Leptospirosis Laboratory of the Institute of Pathobiology, National Institute of Agricultural Technology, Buenos Aires, Argentina and isolated Leptospira strains were genotyped with the technique of Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). The classification procedure employed the VNTR 4, 7, 9, 10, 19, 23, 31, LB4 and LB5, which discriminate strains of L. interrogans and L. borgpetersenii. In Pantanal, 17 wildlife, 65 domestic animals and two humans were examined. In Caatinga, seven wild animals were examined, along with 100 domestic animals and 26 humans. Of 84 blood samples tested in Pantanal, 47 (55.95%) were positive and, of 133 in Caatinga, 59 (44.36%) were reactant. By Fishers exact test, considering a 0.05 significance level, there was no difference between the proportions of serum reagent animals against Leptospira spp. in two biome reviews (p = 0.063). The predominant serovars in SAM reactions were: 1) Pantanal Bratislava (wildlife, dogs and humans), Grippotyphosa (horses and cattle); 2) Caatinga Copenhageni...

Foi investigada a ocorrência de leptospiras e de sororreatividade para leptospiras em animais e seres humanos de seis propriedades rurais localizadas em dois biomas brasileiros que apresentam condições geoclimáticas distintas: Pantanal municípios de Miranda (MS), Itiquira (MT) e Poconé (MT) e Caatinga municípios de Sobradinho (CE), Garanhuns (PE) e Sobral (BA). Em cada uma das propriedades, foram realizadas colheitas de sangue e de urina de animais selvagens de vida livre, animais domésticos e de seres humanos. As colheitas de materiais foram realizadas no período de fevereiro a abril de 2012 no bioma Caatinga e no período de julho a setembro de 2012 no bioma Pantanal. A reatividade sorológica contra Leptospira spp. foi verificada pela técnica de soroaglutinação microscópica (SAM) efetuada com uma coleção de antígenos constituída por 24 sorovares de Leptospira spp. A pesquisa de leptospiras foi efetuada por cultivos de amostras de urina semeadas nos meios Fletcher e de Ellinghausen McCullough Johnson Harris (EMJH). Os cultivos em que houve crescimento de leptospiras foram encaminhados ao Laboratório de Leptospirose do Instituto de Patobiologia, Instituto Nacional de Tecnologia Agropecuária, Buenos Aires, Argentina e as estirpes de leptospiras isoladas foram genotipadas com o emprego da técnica de Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). O procedimento de tipificação empregou os VNTR 4, 7, 9, 10, 19, 23, 31, Lb4 e Lb5, que discriminam estirpes de L. interrogans e L. borgpetersenii. No Pantanal, foram examinados 17 animais selvagens, 65 animais domésticos e dois humanos. Na Caatinga, foram examinados sete animais selvagens, 100 animais domésticos e 26 humanos. Das 84 amostras de sangue examinadas no Pantanal, 47 (55,95%) foram reagentes e, das 133 da Caatinga, 59 (44,36%) foram reagentes. Pelo teste exato de Fisher, considerando-se um nível de significância de 0,05, não houve diferença entre as proporções de animais...

Evaluation of the Diramic system for urine cultures

The use of the Diramic system in microbiological diagnosis of urinary tract infections (UTI) was evaluated. This system was developed at the National Center for Scientific Research of Cuba, and it reads turbidimetric changes of microbial growth in culture media at 37ºC incubated for 4 hours. A total of 396 urine specimens were tested in the Laboratory of Microbiology of the School of Medicine - UNESP, Brazil using the Diramic system and the counting of colony forming units per urine millimeter (calibrated loop) as the reference method. The coincidence rate between the two methods was 96.46% (382 urine samples), and the differences in results were not significant (p 0.05). Sensitivity and specificity rates were 84.37% and 98.80%, respectively. False negative and false positive rates were 2.50% and 1.01%, respectively. The microorganisms isolated from positive urines were: Escherichia coli (68.75%); Klebsiella pneumoniae (10.94%); yeast (6.25%); Pseudomonas aeruginosa (4.69%); Enterobacter cloacae (3.12%); Proteus mirabilis, coagulase negative Staphylococcus, Morganella morganii, and Citrobacter freundii (1.56% each). The Diramic system was effective as screening method for urine cultures, however restrictions in the UTI diagnosis caused by yeasts and patients undergoing antibiotic therapy were negative characteristics of the system.

O sistema Diramic foi avaliado para o diagnóstico das infecções do trato urinário (ITU). O sistema Diramic foi desenvolvido em Cuba e possibilita resultados de diagnóstico das infecções do trato urinário (ITU) em quatro horas e baseia-se na variação da turvação do crescimento microbiano no meio de cultura após incubação a 37ºC/4 horas. 396 amostras de urinas provenientes de ambulatórios e enfermarias do HC da FMB-UNESP-Botucatu/SP foram analisadas pelo sistema Diramic. O método da alça calibrada (AC) foi adotado como método de referência. A taxa de coincidência entre os dois métodos foi de 96,46% (382 amostras de urina), não havendo diferença significativa entre os resultados obtidos nos dois métodos. Os resultados para sensibilidade e especificidade foram 84,37 e 98,80% respectivamente e 10 resultados no Diramic foram falsos negativos (2,5%) e 4 falso positivos (1,01%). Os microrganismos identificados nas urinas positivas foram Escherichia coli (68,75%), Klebsiella pneumoniae (10,94%), leveduras (6,25%), Pseudomonas aeruginosa (4,69%), Enterobacter cloacae (3,12%) e Proteus mirabilis, Staphyloccocus coagulase negativo, Morganella morganii e Citrobacter freundii também foram identificadas (1,56% para cada espécie). O método Diramic foi eficiente na triagem das urinoculturas, porém verificou-se algumas restrições quanto ao diagnóstico das infecções do trato urinário quando causadas por leveduras e em pacientes submetidos a antibioticoterapia.