Urine Culture: Introduction, Importance, sample collection, test procedure

Urine Culture: Introduction, Importance, Sample Collection, Test Procedure and Result Interpretation

Introduction of urine culture and sensitivity

A urine culture test is useful to grow and identify organisms, mainly bacteria, and fungi that may cause a Urinary Tract Infection (UTI). Bladder urine is normally sterile and free from any organisms. UTIs are common in females and children than in adult males. The antibiotic sensitivity test (AST) helps to select an appropriate antibiotic that is effective against specific types of bacteria or fungi causing any infection.

When need Urine Culture and sensitivity Test?

Following conditions that are useful for culture and sensitivity are-

when you’ve experienced pain during urinating, less urine, and also frequent urine symptoms.
When this is prolonged for some time ( 3-4 days) and if the symptoms do not subside, the doctor would then suggest a Urine Culture and Sensitivity test to determine if there is an infection and to what extent.
In many cases, if the urine infection levels have increased, the person may also experience high fever and sudden chills in the body. This may go up to 5-6 days as well, if not detected and cured on time.
Urine culture and sensitivity are used to diagnose, and screen for diseases or medical conditions related to urinary tract infection for persons experiencing symptoms such as frequent and painful urination.

General symptoms of UTIs

Painful or difficult urination with a burning sensation
Increased urination frequency
Urine that smells bad or appears cloudy or reddish
Pain and pressure in the lower abdomen (belly) and back
Feeling Chills
Unexpected fever
Malaise
Tiredness

Why does the urine culture report take 3 days?

No all reports take 3 days. Only positive i.e. growth of organism takes 3 days due to following reasons-

On the first day inoculation of urine on culture media and then incubated for 24 hours.
If the growth of organisms, on the second day perform biochemical tests as well as AST.
On 3 days, report for isolation of bacteria/organism and AST pattern.

Urine collection for culture

Collect Mid-Stream Urine (MSU). Clean the genitals before collection, following these steps to get the sample:

Initial or the first few drops of the urine should be discarded in the toilet.
MSU samples should be collected in the sterile container provided.
The end of the urine should not be collected. Cap the container.
If delay in test processing, keep it in the refrigerator or a cool place during the collection period.

Test procedure of Urine culture and sensitivity

On the first day

Culture urine Specimens

Blood agar
Incubate aerobically
MacConkey agar
Incubate aerobically

Or alternate of these two, you can use CLED agar

Day 2 and Onwards

Examine and Report Cultures of Urine Specimens
Blood agar and MacConkey agar cultures
Look particularly for:

E. coli
Proteus species
Klebsiella species
Enterococcus species
S. saprophyticus (10-30% of young women)
Pseudomonas
Providentia
Citrobacter
Serratia

Biochemical tests

Depending on the nature of organisms

Antimicrobial susceptibility test

Antimicrobial sensitivity pattern also depends on the nature of organism involvement

On 3rd day

Organism isolated

Antimicrobial sensitivity pattern

Sensitive (S)

Resistant (R)

Intermediate (I)

Result and interpretation

No growth after 24 hours of incubation at 37°C.

or > 10⁵CFU/ml of organism (E. coli) isolated

AST pattern

Antibiotic – Sensitive

Antibiotic- Intermediate

Antibiotic-Resistant

Reference Range

>100,000 colonies/ml : Positive

10,000-100,000 colonies/ml: Indeterminate

<10,000 colonies/ml: Negative

Positive means that there is a certain amount of bacteria or organisms that have been found in the Urine Sample and that the infection is certainly because of these bacteria. The Culture report not only detects the various types of germs present but also shows its sensitivity to various Antibiotics. This means you can gauge from this report itself that which antibiotics would provide maximum benefit.

Possible pathogens of urine

Bacteria
Gram-positive

Staphylococcus saprophyticus
Enterococcus species

Gram-negative

Escherichia coli
Proteus species
Klebsiella species
Pseudonomas aeruginosa
Providentia
Citrobacter
Serratia
Fungi
Candida albicans
Parasites
Trichomonas vaginalis (trophozoite)
Enterobius vermicularis (Ova)
Schistosoma hematobium (ovum)

Commensals
Any commensal organisms found in urine are usually those that have contaminated the specimen from the urethra and they are-
Micrococci
Diphtheroids
Candida species

Mycoplasma species

Mycobacterium smegmatis

Acinetobacter species

Bibliography

Bailey & Scott’s Diagnostic Microbiology. Editors: Bettey A. Forbes, Daniel F. Sahm & Alice S. Weissfeld, 12th ed 2007, Publisher Elsevier.
Clinical Microbiology Procedure Handbook Vol. I & II, Chief in editor H.D. Isenberg, Albert Einstein College of Medicine, New York, Publisher ASM (American Society for Microbiology), Washington DC.
Colour Atlas and Textbook of Diagnostic Microbiology. Editors: Koneman E.W., Allen D.D., Dowell V.R. Jr, and Sommers H.M.
Jawetz, Melnick and Adelberg’s Medical Microbiology. Editors: Geo. F. Brook, Janet S. Butel & Stephen A. Morse, 21st ed 1998, Publisher Appleton & Lance, Co Stamford Connecticut.
Mackie and Mc Cartney Practical Medical Microbiology. Editors: J.G. Colle, A.G. Fraser, B.P. Marmion, A. Simmons, 4th ed, Publisher Churchill Living Stone, New York, Melborne, Sans Francisco 1996.
Manual of Clinical Microbiology. Editors: P.R. Murray, E. J. Baron, M. A. Pfaller, F. C. Tenover and R. H. Yolken, 7th ed 2005, Publisher ASM, USA
Textbook of Diagnostic Microbiology. Editors: Connie R. Mahon, Donald G. Lehman & George Manuselis, 3rd edition2007, Publisher Elsevier.
Topley & Wilsons Principle of Bacteriology, Virology and immunology Vol I, II, III, IV & V. Editors: M.T. Parker & L.H. Collier, 8th ed 1990, Publisher Edward Arnold publication, London.
Medical Microbiology-The Practice of Medical Microbiology Vol-2-12th Edn. –Robert Cruickshank
District Laboratory Practice in Tropical Countries – Part-2- Monica Cheesebrough- 2nd Edn Update
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082698/
https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702008000400020
https://academic.oup.com/jtm/article/14/5/334/1808850

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