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