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​Lab Guide
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Test ID: Urine Microscopy/reflex culture
Urine Microscopy/reflex culture
Culture of urine by conventional culture
Useful For

Diagnosis of urinary tract infections
Method name and description

Conventional semi-quantitative culture technique
Reporting name

Urine Microscopy/reflex culture
Clinical information

Urinary tract infection (UTI) results from the presence and multiplication of microorganisms, in one or more structures of the urinary tract, with associated tissue invasion. This can give rise to a wide variety of clinical syndromes. These include acute and chronic pyelonephritis (kidney and renal pelvis), cystitis (bladder), urethritis (urethra), epididymitis (epididymis) and prostatitis (prostate gland). Infection may spread to surrounding tissues (e.g. perinephric abscess) or to the bloodstream. Protection against infection is normally given by the constant flow of urine and regular bladder emptying. Urine is a poor culture medium for many bacteria due to its acidity, high urea concentration and variable osmolality and, in men, possibly partly as a result of antibacterial activity of prostatic secretions.
Aliases
  • Urine M, C and S
  • Urine culture
  • Culture Urine
  • C Urine

 
Specimen type / Specimen volume / Specimen container

Specimen type:

  • Mid-stream urine 
  • Catheter urine
  • Suprapubic aspirate
  • Nephrostomy urine
  • Cystoscopy urine
  • Ileal conduit urine

 

Specimen volume:

  • > 5ml if available. 
  • Smaller volumes can be accepted from neonatal and anuric patients but microsopy may not be possible on such samples
  • If collected in boric acid container- fill upto the marked dotted line (20 ml). Note: underfilling or overfilling may compormise the integrity of the specimen during storage and transport

 

Specimen container:

  • Sterile leak proof container 
  • If delay, collect urine in container with boric acid preservative.
  • NOTE: The 10mL sterile container should be used for pediatric patients. 

          
Collection instructions / Special Precautions / Timing of collection

Collection instructions

The person obtaining the specimen should wash their hands with soap and water, rinse and dry. ·

If the patient is collecting the specimen, he should be given detailed instructions.

 

Midstream urine collection (female): · Cleanse the urethral opening and vaginal vestibule area with soapy water or clean gauze pads soaked with liquid soap. · Rinse the area well with water or wet gauze pads. Hold Labia apart during voiding. Allow a few milliliters to pass. Collect the midstream portion of urine in a sterile container.

 

Midstream urine collection (male): · Cleanse the penis, retract the foreskin (if not circumcised), and wash with soapy water. Rinse the area well with water. · Keeping foreskin retracted; allow a few milliliters of urine to pass. Collect the midstream portion of urine in a sterile container.

 

Ileal conduit urine: · Remove the external urinary appliance and discard the urine within the appliance. · Gently swab and clean the stoma opening with a 70% alcohol pad and then with an iodine solution. Remove excess iodine with an alcohol pad. · Using sterile technique, insert a double catheter into the stoma. · Catheterize the ileal conduit to a depth beyond the fascial level. · Collect the urine drained into a sterile container.

 

Indwelling catheter urine collection: · Clean the catheter collection port with a 70% alcohol swab. · Using sterile technique, puncture the collection port with a needle attached to a syringe. · Aspirate the urine and place it into a sterile container. · NOTE: Do not collect urine from the drainage bag because growth of bacteria outside the catheter may have occurred at this site.

 

Urine collection via catheter (pediatric patients): · Clean the patient's urethral opening (and in females the vaginal vestibule) with soap, and carefully rinse the area with water. · Using sterile technique, pass a catheter into the bladder. Discard the initial few ml of urine. Collect a sample from the mid- or later flow of urine in a sterile container. ·

NOTE: Urine catheter tip cultures are not acceptable.

 

Suprapubic aspirate: Collect aseptically in line with organization procedures

 

Cystoscopy urine: Collect aseptically durng the cystoscopy procedure

 

Timing of collection

Prior to antimicrobial therapy
Relevant clinical information to be provided
  • Antimicrobial therapy 
  • Patient clinical condition
  • Specify method of collection e.g.Midstream, catheter, nephrostomy urine, cystoscopy urine, suprapubic aspirate, etc.

 
Storage and transport instructions
  • Send immediately to the laboratory if possible. For any delay likely to exceed 2 hours from collection,  refrigerate at  2-8° C (sample should reach the laboratory within 24 hrs of collection)
  • For specimens in boric acid container, keep at room temperature  for up to 24 hrs.

 
Specimen Rejection Criteria
  • Urine collected from bag of catheterized patients 
  • Foley's catheter tips
  • 24hr urine specimens 
  • Delayed specimen received more than 24 hrs after collection  in boric acid container or more than 2hrs after collection in plain container without refrigeration.
  • Duplicate specimen within 72 hrs. 
  • Leaking container
  • No relevant clinical details provided with the request. (Please note that where applicable, the relevant clinical details should reflect those on the patient’s electronic record at the time the order was placed).
Biological reference intervals and clinical decision values

Microscopy.

  • ≥ 10 WBC/ µl and/or  ≥ 10 RBCs/µl
  • Presence of casts and crystals 

Culture:

  • Significant isolates identified and reported along with antimicrobial  susceptibilities..
Factors affecting test performance and result interpretation
  • Improper collection
  • Improper processing 
  • Antimicrobial therapy
  • Improper container

 
Turnaround time / Days and times test performed / Specimen retention time

Turnaround time

  • Microscopy: 24 hrs.
  • Culture: 48-72 hrs.

Days and times test performed

  • Daily from 7 am to 3 pm in HGH and AAH microbiology laboratories and 24/7 in AWH and TCH microbiology laboratories 

 

Specimen retention time

48 hrs. after final report

Hamad Medical Corporation

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