What Does Commensal Flora Present In Urine Culture Mean


Urine Good Hands: Diagnosing UTIs With Urine Cultures

These diseases include cystitis, which is particularly prevalent in women and causes discomfort while urinating, as well as more serious infections that affect the kidneys. Cystitis is the most frequent type of urinary tract infection, which may be quite painful (pyelonephritis). As a physician, you’re certainly familiar with the process of collecting urine samples from patients who are experiencing UTI symptoms, as well as the process of receiving and acting on the results of those samples. The question is: What exactly happens to that pee, as well as the organisms that may grow from it, between when it exits your bladder and when the report is recorded in your medical file?

From the Bladder To the Cup To the Bench

The technique of collecting is one of the most significant aspects to consider throughout the process of cultivating urine. Despite the fact that the bladder is typically regarded to be a sterile environment (although this is not always the case, as we shall explore later), the external genitalia are colonized by commensal bacteria, which can contaminate urine samples and eventually thrive in culture. Asuprapubic aspiration, in which a needle is introduced directly into the bladder through carefully cleaned skin, is the most effective means of avoiding the possibility of urogenital contamination.

A Foley catheter can be used to collect urine from infants, young children, and others who are unable to urinate directly into a specimen container (for example, people who have aneurogenic bladder).

  • Cathode ray tube (Foley catheter).
  • The use of a midstream clean-catchapproach for voided urine specimens is advised in order to reduce the probability of contamination.
  • (By contrast, the much-maligned “bagged pee” collection method, which involves collecting urine in a plastic bag that is taped to the perineum, may not be as susceptible to clinically significant contamination as is commonly supposed.
  • Once a urine sample has been taken, it must be sent to a laboratory for testing and analysis.
  • After collection, if the urine sample is allowed to cool to room temperature, it should be plated within 2 hours.

The interval between sample collection and plating can be prolonged to 24 hours if the sample is kept refrigerated or transferred in a container containing boric acid as a preservative, as described above.

The Preview: Urinalysis

When bacteria from a urine sample grow to a sufficient number that they can be discovered and identified using normal clinical microbiology lab procedures, it generally takes at least one day to confirm that bacteria are not present in the culture. Urinalysis, on the other hand, can provide crucial information regarding the possibility of a UTI in a short period of time. By doing a urinalysis, it is possible to identify and quantify white blood cells in the urine, which represent the inflammation that is characteristic of infection.

  • Urinalysis can also detect the presence of nitrites, which are formed by gram-negative bacteria that are capable of converting nitrates to nitrites; among these bacteria is Escherichia coli, which is the most prevalent cause of urinary tract infection (UTI) in humans.
  • It is possible that the findings of a urine analysis will provide information about other parameters in the urine, such as pH and the presence or absence of red blood cells, protein and other components, which may be indicative of a range of kidney illnesses unrelated to infection.
  • When a UTI is not detected, however, it is less probable that the source of the symptoms is an infection of the urinary tract (UTI).
  • Studies of such techniques have revealed that they may be helpful in lowering needless antibiotic usage while remaining safe.

The Main Feature: Culture

If a urine sample is sent to a clinical microbiology lab, it is typically plated onto two types of media: an aMacConkey agarplate, which inhibits growth of gram-positive bacteria while also allowing some early predictions about the identity of gram-negative bacteria, and a blood agar plate, which allows the growth of lactose-fermenting organisms such as Escherichia coli on a urine biplate with MacConkey agar (L (R).

  • Thea Brennan-Krohnof nearly all bacteria that cause urinary tract infections is the source of this information.
  • Because of its capacity to ferment lactose, E.coli grows as pink colonies on MacConkey agar.
  • A more effective plating method is achieved by using urine biplates, in which each of the two kinds of agar fills half the plate.
  • If there is no growth at this stage, the plates may be cultured for an extra day and then re-examined.

A calibrated inoculating loop that takes up either 1 or 10 mL of urine is used to plate urine cultures quantitatively; when colonies develop on the agar, the number of colony-forming units per milliliter (CFU/mL) may be estimated by multiplying the number of colonies by 1000 or 100, respectively.

Interpreting the outcomes of the culture involves taking into consideration the identification of any organisms that grow, the amount in which they develop, and the specimen type that was used to create the culture.

Although the comprehensive reporting algorithms are sophisticated and differ to some extent among laboratories, there are key concepts that are shared by all of them:

  • Only one or two types of bacteria grow and are present in large quantities (i.e., 10,000 CFU/mL), they are almost always identified at the species level and reported as such
  • However, when many types of bacteria grow and are present in large quantities (i.e., >10,000 CFU/mL), they are almost always identified at the species level and reported as such
  • When three or more varieties of bacteria grow and no one one dominates (i.e., none is present at 100,000 CFU/mL), the findings are referred to as “mixed bacterial flora,” and the results are reported as “mixed bacterial flora.”
  • Even when bacteria are present in lower concentrations (for example 10,000 CFU/mL), they may be reported in greater detail if they are obtained from specimens that are more likely to be sterile (for example, catheterized urine) rather than specimens that are more likely to be contaminated (for example, voided urine). Atypical uropathogens (e.g., Streptococcus species) are not routinely tested for antimicrobial sensitivity
  • Hence, these organisms are not tested.

They are intended to guarantee that bacteria that cause disease are correctly reported so that patients may be treated, while minimizing superfluous reporting of bacteria that are highly unlikely to be causing a UTI in order to reduce overuse of antibiotics. In some clinical situations, such as when a patient has indwelling urinary tract hardware, it may be necessary to evaluate a mixed culture or a culture that contains an organism that is not typically associated with uropathogens in greater depth.

Because of the relative simplicity with which a urine specimen may be obtained and the quick development of most uropathogens in culture, urinary tract infection (UTI) is generally seen as an easy diagnosis.

Medical laboratory professionals, using their experience in colony recognition in conjunction with detailed algorithms, must balance the need for a diagnosis with the risk of obtaining Too Much (clinically irrelevant) Information.

The significance of urine culture with mixed flora

Cultures of urine that contain more than one organism are generally regarded to be tainted. The frequency with which such development constitutes a true mixed infection is not known at this time. Surprisingly few research have been conducted to determine the clinical importance of polymicrobial development resulting from urine production. In these research, the relevance of the same combination of microorganisms recovered from blood and urine in instances of urosepsis was proven, as was the repeatability of the same mixture of bacteria recovered from successive urine cultures.

Bacteriuria associated with long-term catheterization, the most frequent nosocomial infection in medical care facilities in the United States, is primarily polymicrobial in composition.

To provide the best possible therapy for these patients, early species identification and antibiotic susceptibility testing of each urine isolate may be of critical importance.

Similar articles

  • The importance of polymicrobial development in urine: is it a source of pollution or a source of genuine infection? Siegman-Igra Y, Kulka T, Schwartz D, Konforti N.Siegman-Igra Y, Kulka T, Schwartz D, Konforti N.Siegman-Igra Y, et al. 1993
  • 25(1):85-91. Scand J Infect Dis 1993
  • 25(1):85-91. Sweden’s journal of infectious diseases published a prospective study of urinary tract infections and urine antibodies after radical prostatectomy and cystoprostatectomy in 1993 with the PMID: 8460355. .Adukauskiene D, Kinderyte A, Tarasevicius R, Vitkauskiene A.Adukauskiene D, et al.Medicine (Kaunas). 2006
  • 42(10):805-9.Medicine (Kaunas). 2006
  • 42(10):805-9
  • .Adukauskiene D, Kinderyte A, Tarasevicius R, Vitkauskiene A.Ad .de Toro-Peinado I, Concepción Mediavilla-Gradolph M, Tormo-Palop N, Palop-Borrás B.de Toro-Peinado I, Concepción Mediavilla-Gradolph M, Tormo-Palop N, Palop-Borrás B.de Toro-Peinado I, et al.Enferm Infecc Microbiol Clin.2015 Catheter-associated urinary tract infections are discussed in detail in Spanish. Warren JW.Warren JW.Warren JW.Warren Journal of Infectious Diseases, North America, 1997 Sep
  • 11(3):609-22. doi: 10.1016/s0891-5520(05)70376-7. Journal of Infectious Diseases, North America, 1997. PMID:9378926 Review

Cited by 9articles

  • A reevaluation of the routine midstream culture in the diagnosis of urinary tract infection is presented. Sathiananthamoorthy S, Malone-Lee J, Gill K, Tymon A, Nguyen TK, Gurung S, Collins L, Kupelian AS, Swamy S, Khasriya R, Spratt DA, Rohn JL. Sathiananthamoorthy S, Malone-Lee J, Gill K, Tymon A, Nguyen TK, Gurung S, Collins L, Kupelian AS, Swamy S, Khasriya R, Infection Control and Hospital Epidemiology, 2019 Feb 27, 57(3):e01452-18. doi: 10.1128/ICM.00218. Print 2019 Mar. 2019.PMID:30541935 Journal of Clinical Microbiology Progress in Automated Urinalysis is a free PMC paper available online. Oyaert M, Delanghe J.Oyaert M, et al. Oyaert M, et al. Journal of Laboratory Medicine and Pathology 2019 Jan 15
  • 39(1):15-22. doi: 10.3343/jlmph.2019.39.1.15. Journal of Laboratory Medicine and Pathology 2019.PMID:30215225 PMC article that is completely free. Review of the creation and validation of multiple decision-making algorithms to forecast urine culture growth based on a parameter measured by urine flow cytometry, including Müller M, Seidenberg R, Schuh SK, Exadaktylos AK, Schechter CB, Leichtle AB, Hautz WE.Müller M, Seidenberg R, Schuh SK, Exadaktylos AK, Schechter CB, Leichtle AB, Hautz WE.Müller M, et al. PloS One. 2018
  • 13(2):e0193255. doi: 10.1371/journal pone.00193255. Published online February 23, 2018. eCollection for the year 2018. Journal of the PLoS One. 2018.PMID:29474463 PMC article that is completely free. Study of the microbial ecology linked with pyuria and symptoms of overactive bladder in a blinded observational cohort of patients Gill K, Kang R, Sathiananthamoorthy S, Khasriya R, Malone-Lee J, et al. Gill K, Kang R, Sathiananthamoorthy S, Khasriya R, Malone-Lee J, et al. Int Urogynecol J. 2018 Oct
  • 29(10):1493-1500
  • Abstract available online. This article’s doi is: 10.1007/s00192-018-3558-x. Publication date: February 17, 2018. PMID: 29455238 International Urogynecol J. 2018. PMC article is provided for free. Diagnostic tools for urinary tract infections are constantly evolving and improving. Davenport M, Mach KE, Shortliffe LMD, Banaei N, Wang TH, Liao JC. Davenport M, Mach KE, Shortliffe LMD, Banaei N, Wang TH, Liao JC. Davenport M, et al. 2017 May
  • 14(5):293-310. Nat Rev Urol. 2017 May
  • 14(5):296-310. doi: 10.1038/nrurol.2017.20. Published online first on March 1, 2017. National Review of Urology, 2017.PMID:28248946 PMC article that is completely free. Review
You might be interested:  What Is A Culture Index

FAQs: Urinary Tract Infection (UTI) Events

Non-Catheter-Associated Urinary Tract Infection and Other Urinary System Infection are all types of urinary tract infections that might occur after a catheter is inserted.

Spinal cord injury, heavily sedated, or ventilated patients

It is possible that surveillance criteria are not equally sensitive across all patient populations. Individuals with spinal cord injuries, patients with brain traumas, and patients who have been profoundly sedated are examples of patient groups in whom the UTI criteria may not be as sensitive. NHSN developed its Surveillance criteria in order to strike a balance between sensitivity and specificity, as well as practicalities. A set of criteria that encompassed every demographic with high specificity and sensitivity would be far too hard to apply consistently across various facilities, as demonstrated by the results of the study.

Mechanical ventilation or sedation does not necessarily imply that patients will be unable to communicate their discomfort verbally.

100,000 CFU/ml included in more than 1 laboratory category

In some patient populations, the sensitivity of surveillance criteria may not be the same as in others. Individuals suffering from spinal cord injuries, those suffering from brain traumas, and those who have been profoundly sedated are examples of patient groups in whom the UTI criteria may not be as sensitive. Achieving a balance between sensitivity and specificity, as well as practicalities, was important when NHSN developed its Surveillance definition. To deploy consistently across multiple facilities a set of criteria with high specificity and sensitivity for every group would be just too hard to manage.

The use of mechanical ventilation or sedation does not necessarily imply that patients will be unable to communicate their discomfort verbally.

Q2. Can I use positive cultures reported as 75-100,000 CFU/ml to meet the UTI definition?

You must check with your laboratory to see if they can decide whether or not at least 100,000 CFU/ml of bacteria have been discovered in the urine culture, and if so, whether or not to report it as less than 100,000 CFU/ml of bacteria. Some laboratories have been successful in resolving this issue. Use of a culture for NHSN UTI surveillance should be avoided when this is not possible. If they cannot, and you are unable to be certain that a culture contains at least 100,000 CFU/ml because the lab reported it to be between 75,000 and 100,000 CFU/ml, don’t use the culture for NHSN UTI surveillance.

Mixed flora

It is not possible to utilize this urine culture in an NHSN UTI determination since it does not meet their criteria. A positive urine culture containing two or fewer species does not fulfill the requirements for a positive urine culture containing two or fewer organisms since a “mixed flora”* indicates that at least two organisms are present, in addition to the identified organism.

A urine culture obtained in this manner cannot be utilized to fulfill the NHSN UTI requirements. * The same is true for the flora of the perineum, the normal flora, and the vaginal flora.

Morphology determining what equates to2 organisms

  • In this case, Ecoli1 100,000 CFU/ml, Ecoli 210,000 CFU/ml, and Staph Aureus100,000 CFU/ml are regarded as two different species.

To the best of our knowledge, NHSN surveillance identification of an organism to the genus or species level is the most accurate you can obtain for reporting reasons. For example, Escherichia coli (genus) or Enterococcus species are the most accurate you can get for reporting purposes. E. coli types 1 and 2 are regarded to be a single organism, and similarly, Enterococcusspecies 1 and 2 are considered to be a single organism, and so on. The findings of antimicrobial susceptibility testing and the variation in colony shape do not imply the presence of distinct organisms.

Multiple colony counts for the same organism

I have the following final lab result for a patient who may be included in my probable CAUTI report:

  1. Aeruginosa 1: 50,000 to 100,000 colonies per milliliter of water
  2. Aeruginosa 2: 50,000 to 100,000 colonies per milliliter of water
  3. And Aeruginosa 3: 5,000 to 50,000 colonies per milliliter of water

Q5. Since these are the same organism, they would add up to 110K CFU/mL, would this be considered 1 organism of100K and an acceptable culture to meet the UTI criteria?

Yes. For the purposes of NHSN UTI surveillance, when two or more organisms found in urine are identified to the same genus and species level but have different colony morphology or antibiograms (indicated by strain 1 or strain 2, colony A or colony B, for example), the organisms should be considered the same, and if the sum total of the colony counts is less than 100,000 CFU/ml, the culture result is eligible for use in meeting a UTI definition.

If the organisms If two antibiograms are available and the sensitivities for the same species differ, always report the panel with the higher level of resistance.

Number of organisms in cultures

Do not combine cultures from different countries. In a single urine culture, the presence of more than two organisms indicates that the material may have been contaminated. However, this is not the case for distinct urine cultures that contain fewer than three organisms in each. Using the above illustration, the first culture would be suitable for a UTI. After determining that there was no UTI linked with the first urine culture, the second urine culture may be examined for UTI because there had been no prior UTI RIT established and there were no more than 2 organisms in the second urine culture.

Identifying single vs multiple UTIs

Yes. The Repeat Infection Timeframe is the term used to describe this period of time (RIT). Please refer to the material on RIT contained in Chapter 2 ” Identifying Healthcare-Associated Infectionspdf icon” of the NHSN handbook for further information.

Patient reported fever

This can be utilized to assess whether or not the criteria of a POA infection is satisfied if a patient reports a temperature over 38.0°C (or over 100.4 0F) within the POA timeframe and within the IWP of a positive urine culture during this timeframe. It is not permissible to utilize a generic report of “fever” by the patient without an accompanying temperature measurement.

UTI Symptom: dysuria

A UTI is not the same as dysuria and therefore cannot be used to fulfill the criteria of a urinary tract infection.

UTI Symptoms: urinary urgency, urinary frequency and dysuria

Q10: Can another recognized cause of urine urgency, urinary frequency, or dysuria be found in a patient who has a history of urinary urgency, urinary frequency, or dysuria? No, the phrase “with no other acknowledged cause” does not applicable to the symptoms described above. Even in the presence of a positive urine culture, which may have been obtained as part of a differential diagnosis for suspicion of UTI, it would be extremely unlikely that there is another associated cause for the urinary urgency, urinary frequency, and dysuria that are characteristic of UTI symptoms.

Q11: Can these symptoms be used on the same day when the indwelling urinary catheter was removed and reinserted?

Yes. It can be utilized as an element even if the indwelling urine catheter was not in situ at the time of the symptom if the symptoms happened on a day when the indwelling urinary catheter was in place for a portion of the day.

Costovertebral angle (CVA) pain or tenderness

Lower back or flank discomfort on either side of the body is acceptable. A generalized “low back pain” diagnosis in the medical record does not always indicate pain or discomfort associated with a CVA, because there are other causes of low back pain.

Suprapubic tenderness

There are other causes of stomach discomfort, and this symptom is far too widespread to correspond to the specific UTI sign of suprapubic soreness, which is more localized. In order to fulfill the NHSN’s UTI symptom of suprapubic tenderness, low abdomen pain or bladder discomfort are acceptable symptoms to present with.

“With No other recognized cause”

Individuals responsible for NHSN UTI surveillance in your organization who have access to the entire medical record and clinical picture should make the clinical decision about “with no other recognized cause” for UTI signs/symptoms of suprapubic tenderness or costovertebral angle pain or tenderness. The clinical judgment conclusion must be contested and supported by medical record data, and in the event that the case is validated, there must be a clear explanation of why it was made. Generally speaking, here’s what you should do: It would appear that the presence of UTI signs/symptoms within the IWP of a positive urine culture would imply that the symptom is a UTI symptom associated to the positive urine culture, which may have been obtained based on suspicion of UTI.

Leg bags/attaching urometers

Alternatively, my intensive care unit opens catheter systems in order to replace catheter bags with urometers. Is it appropriate to include them under CAUTI monitoring, given that the system is not “closed?” Yes. Both of these techniques have the potential to raise the risk of UTI, and patients who engage in any of these practices should be included in CAUTI surveillance.


CMS receives only catheter-associated UTI data (including ABUTI and SUTI), which are not shared with other organizations. It is important to remember that ABUTI can arise in individuals who have or do not have an indwelling urinary catheter. A CAUTI is therefore created when a patient in one of these locations suffers from an ABUTI while also having an indwelling urinary catheter in a timely manner to comply with the device-associated rule. If CAUTI reporting in the location is included in your monthly reporting plan, this CAUTI will be reportable to CMS.

Device attribution

No, patients who have colovesical, enterovesical, or rectovesical fistulae are not disqualified from satisfying the NHSN UTI criteria of urinary tract infection. NHSN infection surveillance is targeted at detecting risks to patients that are a result of device usage in general, rather than at identifying risks associated with a specific device. The presence of an indwelling urinary catheter puts the patient at risk, and as a result, the patient is included in CAUTI surveillance. The goal of sending a urine specimen for culture is to ascertain whether or not there is an infection.

As of right now, the NHSN criteria take into consideration contamination of urine specimens NSHN does not allow specimens having culture results from more than two species (polymicrobial) to be used in satisfying UTI standards because of the risk of contamination.

Secondary BSI and associated urine colony count

No, only the E. coli strain has a colony count that may be used to determine whether or not a UTI is present. Stipulated in Scenario 1 of the Secondary BSI guide (Appendix B of the BSI protocolpdf icon) is the requirement that at least one organism from the blood specimen must match an organism identified from the site-specific infection (in this case, the urine) that is used as an element to meet the NHSN site-specific infection criterion (in this case, the urine). The MRSA with a concentration of 50,000 CFU/ml is not included in the UTI definition.

In addition, the blood samples must have been collected during the UTI secondary BSI attribution period in order to be included.

You might be interested:  What Makes Culture

What information is needed to assist with UTI determination?

  • In the case of an indwelling urinary catheter, the date(s) of insertion/removal will be the same as the admission date. The patient’s age
  • Date(s) and results of urine cultures, including colony count, are recorded. Date(s) of collection, as well as the findings of any positive blood cultures
  • Date(s) and type(s) of UTI signs/symptoms, such as fever (38.0°C), suprapubic tenderness*, costovertebral angle discomfort or tenderness*, urine urgency*, urinary frequency*, dysuria*, and others

These symptoms cannot be utilized while a catheter is in situ since there is no other acknowledged reason. Patients who have an indwelling urine catheter in situ may complain of “frequency,” “urgency,” or “dysuria,” among other things. Please do not submit any personally identifiable information (PII) over the NHSN’s electronic mail system.

Urine Culture

A urine culture is a test that is used to identify microorganisms (such as bacteria) in the urine that may be responsible for the ailment. It is possible for bacteria to enter the urinary tract and produce an infection of the urinary tract (UTI). It is necessary to add a sample of urine to a chemical that encourages the development of germs. If no germs appear to be growing, the culture is considered negative. If germs proliferate, the culture is said to be positive. It is possible to determine the kind of germ by using a microscope or chemical testing.

This may be due in part to the fact that the female urethra is shorter and closer to theanus than the male.

Men also have an antibacterial substance in their prostate gland that helps to reduce their chance of developing prostate cancer.

Why It Is Done

When a urine culture is performed, it may be determined whether symptoms such as discomfort or burning when peeing are caused by a urinary tract infection (UTI). The test can also be used to detect the origin of a UTI, assist in determining the most effective therapy for a UTI, and assess whether the treatment has been effective.

How To Prepare

You will need to obtain a urine sample for testing purposes. You will need to consume enough water and refrain from peeing in order to be able to provide a urine sample. Because bacterial counts will be greater in the first pee of the day, the first urine of the day is the best. It is best not to urinate just before taking this test.

How It Is Done

It is possible that you will be requested to collect a clean-catch midstream urine sample for testing purposes.

Clean-catch midstream urine collection

This approach aids in protecting the urine sample from germs that are generally located on the penis or vaginal area of the subject.

  1. Before collecting the pee, wash your hands well. If the collecting cup has a lid, carefully remove it from the cup. Place the lid on the table with the inside surface facing up. Don’t let your fingertips come into direct contact with the interior of the cup
  2. Make sure the region surrounding your genitals is clean.
  • Men should retract their foreskin if they have one, and wipe the head of their penis with medicated towelettes or swabs
  • Women should spread open the vaginal folds of skin with one hand
  • And men should retract their foreskin if they have one. Then she can use her other hand to wipe the region surrounding the urethra with medicated towelettes or swabs, which will relieve the pain. Ideally, she should clean the region from front to back in order to prevent bacteria from the anus from spreading over the urethra.
  1. Begin urinating into a toilet or urinal as soon as possible. While urinating, a lady should keep her vaginal folds apart
  2. Once the urine has flowed for several seconds, she should insert the collecting cup into the urine stream. Collect approximately 2 fl oz (59 mL) of urine without interfering with the flow of the urine. Move the cup out of the way of the urine flow. Do not allow the rim of the cup to come into contact with your genital area. It is not acceptable to have toilet paper, pubic hair, stool (feces), menstrual blood, or anything else in the urine specimen. Complete your urination into the toilet or urinal. Replace the lid on the cup with care and tighten it down. Then you should return the cup to the laboratory. If you collect the urine at home and are unable to make it to the lab within an hour, place it in the refrigerator.

Other collection methods

In order to collect a urine sample, a health professional must insert a urinary catheter into the bladder of the patient. This procedure is often used to collect urine from a patient in the hospital who is severely unwell or who is unable to give a clean-catch sample using the traditional method. The use of a catheter to collect a urine sample lowers the likelihood of microorganisms from the skin or vaginal region becoming contaminated with the urine sample. It is possible to collect a urine sample from a tiny toddler or infant by utilizing a specific plastic bag that has been taped shut around the entrance (a U bag).

The bag is then carefully removed from the body.

(This procedure is referred to as a suprapubic tap.)

How long the test takes

It will only take a few minutes to complete the exam.

How It Feels

In most cases, there is no discomfort or suffering associated with this test.


There are no known dangers associated with undergoing this test.


The findings of a urine culture are normally available in one to three days. Some bacteria, on the other hand, take longer to proliferate in the culture. As a result, it is possible that results will not be accessible for many days.

Urine culture

Normal: No bacteria or other germs (such asfungi) grow in the culture. The culture result isnegative.
Abnormal: Organisms (usually bacteria) grow in the culture. The culture result ispositive.


As of September 23, 2020, the information is current. Author:Healthwise StaffMedical Review: E. Gregory Thompson, MD – Internal MedicineE. Gregory Thompson, MD – Internal Medicine Dr. Adam Husney is a Family Medicine specialist. Dr. Elizabeth T. Russo specializes in Internal Medicine. As of September 23, 2020, the information is current. Written by a member of the Healthwise teamMedical Review: E. Gregory Thompson, MD, Internal Medicine Dr. Adam Husney is a Family Medicine specialist. Dr. Elizabeth T.

UTIs & Urine Bacteria in Aging: How to Know When Antibiotics Are Needed

Q: An elderly acquaintance, who is in her 90s, has been experiencing bacteria in her urine but has not shown any signs of illness. Due to her continued urinary infection after treatment with antibiotics, the doctor prescribed chronic antibiotics and sent her to urology for further evaluation and treatment. What can be done if an older woman has germs in her urine but no signs or symptoms of illness or disease? Is it possible to benefit from an urological consultation? A: I think this is a fantastic question.

Asymptomatic bacteriuria is something that every elderly person and family caregiver should be aware of.

  • It is quite frequent among older folks. According to estimates, this disorder affects around 20% of women over the age of 80, and it also affects older men. It is more prevalent in older people
  • The older the individual, the more common it is.
  • It’s frequently mistaken for a urinary tract infection (UTI) (UTI). This can result in antibiotic therapy that is unneeded — and even hazardous
  • If this happens,
  • Antibiotics are rarely used in the treatment of this condition. As I’ll discuss further below, research has shown that treating asymptomatic bacteriuria does not result in individuals living better or longer lives. It is possible that this type of therapy is harmful: According to one study, medication increased the likelihood of subsequent (actual) UTIs as well as the likelihood of infection with antibiotic-resistant bacteria.
  • In order to address this illness, it is normal practice for elders to be given antibiotics that are not necessary. Part of the reason for this is because identifying between this disease and a true UTI cannot be accomplished just via the use of a urine test. Instead, health care practitioners must take the time to speak with the patient — or with the patient’s family caregiver — and inquire as to whether any symptoms are present. The importance of this step cannot be overstated in a hectic clinical atmosphere.

Shortly put, this is another another one of those typical aging health conditions that may be easily handled unless older persons and family caregivers are aware of the importance of asking further questions. Asymptomatic bacteriuria should not be treated with antibiotics, according to the Infectious Disease Society of America’s number one “Choosing Wisely” advice. This is due to the high frequency with which antibiotics are provided incorrectly for this illness. This guideline is also included on the Choosing Wisely list created by the American Geriatrics Society.

Now, let’s attempt to prepare you to better grasp this prevalent ailment, shall we? This will save you — and your elderly loved ones — the expense and inconvenience of unneeded tests and antibiotic treatment. In this essay, I’ll go through the following topics:

  • What is asymptomatic bacteriuria and how does it manifest itself
  • What is the prevalence of asymptomatic bacteriuria
  • How to distinguish between asymptomatic bacteriuria and a urinary tract infection
  • Why asymptomatic bacteriuria does not generally necessitate the use of antibiotics

Final thoughts are some practical suggestions for older persons and their family caregivers who are concerned about urinary tract infections (UTIs) and/or germs in the urine.

What is asymptomatic bacteriuria?

Asymptomatic bacteriuria refers to the presence of considerable amounts of bacteria in the urine but the absence of any clinical symptoms of inflammation or illness. In other words, a positive urine culture will be obtained in the case of asymptomatic bacteriuria. It follows that if your healthcare practitioner collects a urine sample and sends it to a clinical laboratory for incubation, a significant amount of bacteria will develop within 1-2 days of the sample being taken. This is referred to as bacterial “colonization” of the bladder when bacteria are present in the bladder but do not cause an inflammatory response to occur.

How common is asymptomatic bacteriuria?

In elderly persons, asymptomatic bacteriuria is more prevalent than many people — including professional doctors — may realize:

  • The prevalence of this illness may be as high as 20% in women over the age of 80. In healthy males over the age of 75, 6-15 percent have been shown to carry bacteria, despite the fact that they do not have UTI symptoms. It has been shown that up to 50% of nursing home patients may have asymptomatic bacteriuria, according to studies.

This disorder affects 2-7 percent of premenopausal women as well as persons with diabetes, and it is more frequent in those with diabetes. In part, this is due to changes in the immune system, which tends to become less strong as individuals age or grow frailer. Asymptomatic bacteriuria becomes more prevalent as people become older, in part because it is associated with changes in the immune system. According to research, asymptomatic bacteriuria in older persons can occasionally resolve on its own, but it can also recur or continue in some cases.

How to tell the difference between asymptomatic bacteriuria and a UTI

By definition, there should be no UTI symptoms present in the case of asymptomatic bacteriuria. Urinary tract infection (UTI) can cause the signs and symptoms listed below.

  • Urination causes burning or pain
  • Increased frequency or urgency of urination
  • And other symptoms. Urine that is bloody
  • Pain in the lower abdomen, flank, or even back
  • Fever

(What about pee that is “cloudy” or “foul-smelling?” The absence of additional symptoms does not provide compelling evidence that this is a reliable method of identifying a potential UTI. Check out this article: “Cloudy, foul-smelling urine is not a diagnostic indicator for urinary tract infection in older adults.” A urine dipstick may be abnormal whether or not an older person has a clinical UTI, in part because certain aberrant readings that are suggestive of UTI may in reality just represent bacterial colonization of the bladder.

You might be interested:  What Is Cheese Culture

Symptoms are very required!

(That “confusion” would be referred to as delirium.) This is especially true for elders who are weak, elderly, or suffering from Alzheimer’s disease or another kind of dementia.

When an older individual with asymptomatic bacteriuria displays evidence of delirium but no other indicators of a urinary tract infection, experts are arguing whether it is acceptable to treat them for a suspected urinary tract infection.

Why asymptomatic bacteriuria usually doesn’t warrant antibiotics

Antibiotic treatment for asymptomatic bacteriuria does not appear to enhance health outcomes in the vast majority of persons, according to the findings of clinical investigations. Except for pregnant women and males preparing to undergo urological treatments, screening for and treatment of asymptomatic bacteriuria are recommended for everyone. A clinical research study conducted in 2015 discovered that treating asymptomatic bacteriuria in women was related with a significantly increased risk of having a urinary tract infection (UTI) later on, and that these UTIs were more likely to be caused by antibiotic-resistant bacteria.

  1. This ailment continues to receive incorrect treatment despite the professional agreement that antibiotics are not necessary in this situation.
  2. In terms of treating or managing urinary bacteria, does cranberries have a place?
  3. Quality clinical research has not been able to demonstrate that cranberry is useful for this purpose, despite several attempts.
  4. However, there was no difference in the number of bacteria or white blood cells found in their urine as a result of this.

It’s Time to Move On,” which summarized many other studies on cranberry for the prevention of UTI and concluded: “The evidence is convincing that cranberry products should not be recommended as a medical intervention for the prevention of urinary tract infections.” An individual has the option, of course, to utilize cranberry juice or pills for whatever purpose she or he sees fit.

Clinicians that support this type of behavior are doing a disservice to their patients.” A 2012 systematic evaluation of high-quality research studies on the use of cranberries for UTI prevention came to the same conclusion: cranberry products did not appear to be beneficial.

In light of the fact that cranberries are unlikely to cause harm to older persons, I have no objections to an older person or family caregiver wishing to consume them. However, I do not recommend it in any way whatsoever.

Practical tips on urine bacteria and possible UTIs in older adults

What should you do if you are concerned about germs in your urine or a suspected urinary tract infection (UTI) in light of this information? Here are some recommendations for older persons and their families:

  • Learn about the prevalence of asymptomatic bacteriuria in elderly persons
  • Asymptomatic bacteriuria is characterized by the presence of positive urine cultures despite the fact that the patient seems to be in good health.
  • Recognize that treating asymptomatic bacteriuria will not benefit the patient and may even cause damage
  • You should be aware that treating asymptomatic bacteriuria will not help and may even cause damage.
  • When it comes to acquiring a urine culture, wait until you’re suffering indications of an impending UTI, such as discomfort when urinating or low abdomen ache.
  • Some healthcare practitioners will do a urine culture “just to be sure” that they are not dealing with UTI. Sometimes patients and their families express a desire to do so. The problem with this approach is that all you may accomplish is discover evidence of asymptomatic bacteriuria (which then has a propensity to be treated incorrectly with antibiotics)
  • A urine test for a probable urinary tract infection (UTI) should only be performed if an older person is having symptoms, according to experts. If a health care professional recommends a urine test and you are not experiencing signs of a urinary tract infection, find out why the test is being recommended.

If you are providing care for an older adult who has dementia or is otherwise prone to delirium, you should consider the following:

  • In the case of an older adult who has dementia or is otherwise prone to delirium, you should take the following precautions:
  • Attempting to do so before doing a urine culture or treating any germs discovered in the urine is still recommended by the experts.
  • Attempting to do so before doing a urine culture or treating any germs discovered in the urine is still recommended by doctors.
  • This argument is explained in detail by a geriatrician in this quite fascinating article: UTI—Another Heavyweight’s Funeral
  • “Urinary Tract Infection”—Another Heavyweight’s Funeral

The following are the advantages and disadvantages of treating asymptomatic bacteriuria in an elderly woman with 90 years of age: Benefits: Antibiotic therapy has not been shown to be beneficial in those who do not have clinical indications of a urinary tract infection. Burdens: Antibiotics are expensive and increase the number of pills a person must take. A danger of side effects, interactions with other drugs, hurting your body’s “good bacteria,” and the development of an illness that is resistant to antibiotics exists with the use of antibiotics.

  • That’s all there is to it.
  • And before you spend time chasing an urological consultation, be sure you get all of your questions answered.
  • As a result, inquire with your physicians about the possibility of asymptomatic bacteriuria.
  • (Unless you’re going to undergo a urological operation, in which case you shouldn’t.) You may even forward these peer-reviewed articles to your colleagues:
  • Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms
  • Diagnosis and Management of Urinary Tract Infection in Older Adults
  • Diagnosis and Management of Urinary Tract Infection in Children. UTI—Another Heavyweight’s Funeral
  • “Urinary Tract Infection”—Another Heavyweight’s Funeral

Treatment of Positive Urine Culture in a Patient Who Does Not Have Urinary Symptoms; Diagnosis and Management of Urinary Tract Infection in Older Adults; and Diagnosis and Management of Urinary Tract Infection in Children and Adolescents. UTI: A Heavyweight’s Funeral; “Urinary Tract Infection”: A Heavyweight’s Funeral

What You Need to Know About Urine Cultures

Your doctor informs you that an aurine culture will be performed. It’s a test to see if you have any germs or bacteria in your pee that might cause an infection of the urinary system (UTI). The urinary system is made up of the kidneys, the bladder, and the tubes that transport your urine (ureters and the urethra). In most cases, an infection begins in the bladder or urethra (the tube your pee comes out of). However, it has the potential to impact any aspect of the system. Infections can cause a burning sensation when you pee, which can be quite uncomfortable.

Having a fever and stomach ache may indicate a more serious infection, so seek medical attention immediately.

What Do I Do for a Urine Culture?

It has been determined that an aurine culture is necessary by your physician. When you urinate, you’ll be tested for germs or bacteria that might cause a urinary tract infection, which can lead to serious health consequences (UTI). It is made up of the kidneys, the gall bladder, and the tubes that take the urine out of the body (ureters and the urethra). It is more common for an infection to begin in the bladder or urethra (the tube your pee comes out of). The system as a whole, however, may be affected.

A burning sensation when you pee might indicate that you have an infection. In other cases, you may have the sensation that you need to go but nothing or only a small amount is released. Having a fever and stomach ache may indicate a more serious infection, which should be treated immediately.

  1. Wipe the area surrounding where you pee with the cleaning pad that was provided to you. Wash your hands. If you’re a woman, spread the outer lips of your vagina and clean it from front to back from front to back from front to back. Men should clean the tip of their penis first, then pee a small amount in the toilet and quit rubbing their penis. Don’t pee in the cup until you’re ready. Then, place roughly 1 or 2 ounces of the mixture in a cup. Make certain that the container does not come into contact with your skin. Complete your peeing in the toilet. A pee capture in the middle of the stream is referred to as a “midstream” urine catch. Wash your hands once more

Some people may require the collection of their sample with the use of a catheter, which is a tiny tube that is inserted into your urethra and into your bladder. This is accomplished with the assistance of a health-care professional. The sample is put in a new, clean container after being cleaned.

What Happens Next?

Your sample is sent to a laboratory for analysis. Some of your urine is collected in a petri plate and kept at room temperature. Any bacteria or yeast present in the sample will reproduce and increase over the course of the following several days. The germs will be examined under a microscope by a lab technician. The different varieties are distinguished by their size, shape, and color. The lab technician will keep track of how many are growing. If it is a real illness, one species of bacteria will generally dominate the situation.

If the culture does not contain any hazardous microorganisms, it is referred to be “negative.” If there are harmful microorganisms developing, this is considered “positive.” E-coli, a kind of bacteria that lives in your intestines, is the most common cause of urinary tract infections.

When Will I Get My Results?

Your doctor’s office will contact you within one to three days. They’ll go through the results with you when they’re done. If you have an illness, you will almost certainly be prescribed antibiotics. If this is the case, make certain you complete the total amount specified. The majority of the time, the infection subsides. However, it is possible that it will return, especially if you are a sexually active woman. In young women, sexual contact increases the likelihood of contracting an infection.

It is important that you take your medication in the manner prescribed by your doctor.

Avoiding Bacterial Contamination of Clean Catch Urine Cultures in Ambulatory Patients in the Emergency Department – Full Text View – ClinicalTrials.gov

BACKGROUND: In the United States, a urinary tract infection (UTI) is a serious public health problem that results in more than 3 million visits to emergency departments every year. As part of the diagnostic process, a sterile urine sample is collected and sent to the laboratory for testing. The “Clean Catch Midstream Urine Sample” is the urine specimen that is desired for testing. When patients are mobile and capable, this specimen is taken in a private restroom by the patient himself. It is possible that the urine sample will be “contaminated” by germs that originated on the skin or in the genital area rather than in the urinary system if the urine sample is not obtained in a sterile way when it is collected.

Occasionally, a contaminated sample might result in an incorrectly positive urine culture result.

Because of the presence of two or more microorganisms in the urine culture, interpreting the results of the urine culture becomes more complicated and prone to inaccuracy.

These surveys illustrate the magnitude of the problem.

A total of 2000 people will be accepted into the study (500 per group).

A self-collected urine sample does not generally need the submission of written consent.

STUDY SETTING: The emergency department of an academic medical facility.

In the United States, all study supplies and materials are readily available on the market.

The four groupings are as follows: Group 1 consists of regular wet wipes and a standard waste disposal container.

Group 3 consists of standard wet wipes and a funnel-shaped container for collection.

The urine samples will be forwarded to the Hospital Microbiology Laboratory for examination and examination.

ANOVA: This study is powered to detect a significant effect size change in any of the study groups (2, 3, or 4) when compared to the control group (group 1). In order to find the method(s) with the lowest rate of urine sample contamination, a suitable sample size must be used.

Leave a Comment

Your email address will not be published. Required fields are marked *