Culture & Sensitivity, Aerobic bacteria Urine (Manual method)

Bacterial/ Viral

Report in 72Hrs

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No Fasting Required

Details

This test detects bacterial infections in the urinary tract (UTI) by culturing a urine sample

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Culture & Sensitivity, Aerobic bacteria Urine (Manual method)

Why is it done?
- Identifies and isolates aerobic bacterial pathogens from urine samples using manual culture techniques to diagnose urinary tract infections (UTIs)
- Determines antibiotic susceptibility patterns of isolated bacteria to guide targeted antimicrobial therapy
- Evaluates symptomatic patients presenting with dysuria, frequency, urgency, suprapubic pain, or flank pain suggestive of UTI
- Monitors treatment efficacy in patients with recurrent or persistent UTIs
- Investigates asymptomatic bacteriuria in pregnant women, immunocompromised patients, or those with indwelling catheters
- Performed when urinalysis or point-of-care tests suggest bacterial infection
Normal Range
- Normal/Negative Result: <10³ CFU/mL (Colony Forming Units per milliliter) or no bacterial growth detected after 24-48 hours of incubation
- Significant Bacteriuria (Symptomatic patients): ≥10⁵ CFU/mL (100,000 CFU/mL) or ≥10² CFU/mL in specimens obtained by catheterization
- Asymptomatic Bacteriuria (women): ≥10⁵ CFU/mL on two consecutive specimens; ≥10² CFU/mL in pregnant women (single specimen)
- Borderline Results: 10³-10⁴ CFU/mL may indicate contamination or low-level infection; repeat specimen recommended
- Mixed Flora: Growth of multiple bacterial species suggests contamination; clean-catch or catheterized specimen preferred
- Sensitivity Results: Reported as Susceptible (S), Intermediate (I), or Resistant (R) to various antibiotics based on minimum inhibitory concentration (MIC)
Interpretation
- Positive Culture (≥10⁵ CFU/mL with single organism): Indicates clinically significant bacteriuria consistent with UTI diagnosis. Bacterial identification and antibiotic sensitivities guide targeted therapy. Most common causative organisms include E. coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus saprophyticus
- Negative Culture (<10³ CFU/mL): Indicates absence of clinically significant bacteriuria. Helps exclude bacterial UTI in symptomatic patients. Consider alternative diagnoses such as viral infection, non-infectious urethritis, or urologic abnormalities
- Susceptible (S) Bacteria: Isolated organism likely to respond to the tested antibiotic at standard clinical doses. First-line antibiotic choice is preferred
- Intermediate (I) Bacteria: Organism may respond to treatment at higher antibiotic concentrations or when the drug is concentrated at the site of infection. Clinical outcome unpredictable; alternative agents often preferred
- Resistant (R) Bacteria: Isolated organism unlikely to respond to tested antibiotic at standard clinical doses. Alternative antibiotic class or combination therapy required. Associated with antimicrobial resistance and treatment failure risk
- Mixed Flora (Multiple organisms): Suggests contamination from skin flora (Corynebacterium, Bacillus, Coagulase-negative staphylococci). Repeat clean-catch midstream or catheterized specimen recommended for accurate diagnosis
- Factors Affecting Results: Specimen collection method (clean-catch vs. catheterized), time to processing, storage temperature, prior antibiotic therapy, urinary pH, presence of crystals, white blood cells, or leukocyte esterase. Delayed processing may result in bacterial overgrowth or death affecting accuracy
- Clinical Correlation: Results must be interpreted within clinical context. Positive culture with pyuria and symptoms confirms UTI. Positive culture without symptoms requires careful evaluation for asymptomatic bacteriuria vs. contamination. Negative culture with clinical symptoms warrants consideration of viral, fungal, or non-infectious causes
Associated Organs
- Primary Organ Systems: Urinary system including kidneys, ureters, bladder, and urethra
- Common Associated Infections: Acute cystitis (bladder infection), acute urethritis (urethra inflammation), acute pyelonephritis (kidney infection), prostatitis (prostate inflammation in males), asymptomatic bacteriuria
- Diseases Diagnosed/Monitored: Urinary tract infections (uncomplicated and complicated), recurrent UTIs, catheter-associated infections, nosocomial urinary infections, urosepsis, obstructive uropathy with secondary infection
- Potential Complications: Untreated UTIs may progress to pyelonephritis and sepsis. Recurrent infections increase risk of renal scarring and chronic kidney disease. Pregnancy complications including preterm delivery and low birth weight with untreated bacteriuria. Antimicrobial resistance development limiting treatment options
- Systemic Effects: Urosepsis and systemic inflammatory response. Bacteremia and hematogenous spread to other organs. Fever, malaise, hypotension, and shock in severe infections
Follow-up Tests
- Repeat Culture (Test of Cure): Recommended 1-2 weeks after completion of antibiotic therapy in complicated UTI, recurrent infections, or pyelonephritis to confirm eradication of pathogens
- Urinalysis with Microscopy: Evaluate for pyuria, hematuria, proteinuria, crystals, and casts. Helps assess inflammation and rule out other urinary pathology. Interpret culture results in clinical context
- Urine Gram Stain: Rapid identification of gram-positive vs gram-negative bacteria before culture results available. Helps guide empiric antibiotic selection
- Blood Culture: Obtain in patients with fever, systemic signs of infection, suspected pyelonephritis, or sepsis to detect bacteremia and identify causative organisms
- Imaging Studies: Renal ultrasound, CT abdomen/pelvis, or voiding cystourethrogram (VCUG) recommended in recurrent UTIs, children, males, or complicated infections to evaluate for anatomic abnormalities, obstructions, or renal scarring
- Renal Function Tests: Serum creatinine and blood urea nitrogen (BUN) in acute pyelonephritis or urosepsis to assess kidney function and guide fluid/electrolyte management
- Complete Blood Count (CBC): Assess for leukocytosis, left shift, or anemia indicating systemic infection or sepsis
- Molecular/PCR Testing: Rapid identification of bacteria and antibiotic resistance genes in some laboratories. Provides faster results than manual culture methods
- Monitoring Frequency: Patients with recurrent UTIs (≥2 in 6 months) require monitoring with repeat cultures before and after treatment. Pregnant women with asymptomatic bacteriuria need culture-based follow-up. Immunocompromised patients may require more frequent monitoring
Fasting Required?
- Fasting Status: NO - Fasting is NOT required for urine culture. This test does not require blood sample collection
- Specimen Collection Instructions: Patient should collect clean-catch midstream urine specimen in sterile container. Females should cleanse vulva with antiseptic wipe in anterior-to-posterior direction, separate labia, and collect middle portion of urine stream. Males should retract foreskin if uncircumcised, cleanse urethral meatus, and collect midstream urine
- Specimen Volume: Minimum 10-20 mL of urine required. If catheterized collection needed, use sterile catheterization technique and collect from catheter lumen, not from drainage bag
- Transport and Storage: Deliver specimen to laboratory within 2 hours of collection at room temperature, or refrigerate (2-8°C) if delay anticipated. Temperature control is critical as bacterial overgrowth or death affects culture accuracy
- Medications to Avoid: No medications need to be withheld before collection. However, avoid starting antibiotic therapy until urine specimen is collected and cultured for optimal culture results. If antibiotics already started, document antibiotic name, dose, and start date on specimen label
- Dietary Restrictions: None required. Normal diet and fluid intake is acceptable. Some practitioners recommend adequate hydration to ensure sufficient urine volume for proper collection
- Additional Preparation: Inform patient about proper collection technique before specimen collection. Avoid menstrual blood contamination in females. Do not use urine collected from diapers or bedpans. Ensure specimen is labeled with patient identification, date, time of collection, and collection method

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