Do Mixed-Flora Preoperative Urine Cultures Matter?

Polin, Michael R.; Kawasaki, Amie; Amundsen, Cindy L.; Weidner, Alison C.; Siddiqui, Nazema Y.

doi:10.14423/smj.0000000000000659

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…Durante el período comprendido entre enero a diciembre 2020, se cultivaron un total de 9 831 urocultivos, de los cuales fueron negativos 4 488 (45,65 %), positivos con recuentos >100 000 ufc/ml fueron 4 209 (42.81%), y flora mixta fueron 1 134 (11,53%). En la práctica clínica el interpretar cultivos de flora mixta como negativos es apropiado [12]. El 45,65% fueron urocultivos negativos.…”

Section: Resultsunclassified

Infección comunitaria del tracto urinario por Escherichia coli en la era de resistencia antibiótica en Ecuador

Solís¹,

Romo

Granja³

et al. 2022

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Las infecciones del tracto urinario (ITU) se encuentran entre las enfermedades infecciosas más frecuentes que afectan a los seres humanos y representan un importante problema de salud pública con una carga de morbilidad y de altos costos sanitarios especialmente cuando se complican. Los objetivos de este estudio son actualizar los patrones de resistencia a los antibióticos utilizados para las ITU causadas por E. coli comunitaria, comparar la resistencia antimicrobiana con otros datos publicados en Ecuador y sugerir varias estrategias para superar los desafíos que se presentan en el trabajo diario del laboratorio y la práctica clínica asociados con este importante problema. Resultados: Se aislaron 3341 Escherichia coli (79,38%), 299 Klebsiella pneumoniae (7,1%), 192 Enterococcus faecalis (4,56%), y otros microorganismos en el resto de muestras. Las alternativas de tratamiento empírico para E. coli son: nitrofurantoina, fosfomicina, amoxicilina/clavulanato, cefuroxima, ampicilina/sulbactam. E. coli productora de BLEE se encontró en 612 muestras (18,4%). Conclusión: es fundamental vigilar la resistencia bacteriana a nivel de comunidad, los datos obtenidos de la vigilancia hospitalaria no deben ser extrapolados a la comunidad.

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Section: Resultsunclassified

Infección comunitaria del tracto urinario por Escherichia coli en la era de resistencia antibiótica en Ecuador

Solís¹,

Romo

Granja³

et al. 2022

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“…Mixed urine cultures were defined by Duke University Microbiology Laboratory as the presence of 2 or more organisms when all organisms are nonsignificant (not a known uropathogen) or when 1 of the organisms is considered a significant uropathogen but is in lesser quantity (∼10-fold fewer) than the concentration of the nonsignificant organisms: for example, 1,000 colony-forming units per milliliter (CFU/mL) of significant compared with 10,000 CFU/mL of nonsignificant organisms. 3…”

Section: Definitionsmentioning

confidence: 99%

“…1 Preanalytic contamination of urine cultures during the collection phase can lead to falsely positive or mixed flora urine cultures, which in turn leads to inappropriate antibiotic use. [2][3][4] Diagnostic stewardship interventions should focus on collection of urine specimens to reduce the occurrence of mixed urine culture results and provide opportunity for safe de-escalation of antimicrobials. 5 We evaluated the incidence of and defined risk factors for mixed urine cultures in an outpatient urology clinic, and we reviewed the impact of patient education on the incidence of mixed urine cultures.…”

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confidence: 99%

Investigating risk factors for urine culture contamination in outpatient clinics: A new avenue for diagnostic stewardship

Whelan

Nelson

Kim

et al. 2022

ASHE

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“…Urine culture is the standard of care (SOC) for the detection and identification of pathogens causing UTIs. However, culture-dependent approaches are focused on an Enterobacterales-centric paradigm which is based on assumptions that urine is sterile (10)(11)(12)(13)(14), disregards mixed infections as contamination (15)(16)(17), and is based on clinical studies employing heterogeneous definitions and thresholds for a UTI (18,19). Culture has several limitations, including: (1) an inability to identify hard-to-grow microbial organisms, such as anaerobes and fungi; (2) challenges in identifying rare pathogens or organisms not routinely cultured; and (3) risk of false negative results for patients being treated with antibiotics (20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Analytical Validation of a Highly Accurate and Reliable Next-Generation Sequencing-Based Urine Assay

Couto-Rodriguez,

Danko,

Wells

et al. 2024

Preprint

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Culture is currently the gold standard for diagnosis of urinary tract infections (UTIs); however, it has poor sensitivity detecting urogenital pathogens, especially if patients have already initiated antimicrobial therapy, or have an infection from an organism that is not commonly cultured. False negative urine culture results can lead to the inappropriate use of antimicrobial therapies or to the progression to urosepsis in high-risk patients. Though not commonly applied to urine in a clinical setting, Next-generation sequencing (NGS)-based metagenomics offer a solution as a precision diagnostic. We developed and validated BIOTIA-ID, a clinical-grade NGS-based diagnostic pipeline for the detection and identification of pathogens in urine specimens. Remnant clinical urine specimens, and contrived sterile urine spiked with common UTI pathogens, were processed with our end-to-end assay including extraction, metagenomic library preparation and Illumina NextSeq 550 sequencing. We trained and applied a bioinformatic pipeline that uses machine learning (ML) to identify pathogens. Internal controls and other quality control measures were incorporated into the process to provide rigorous and standardized results. The assay was tested on 1,470 urine specimens and achieved 99.92% sensitivity, 99.95% specificity and a limit of detection (LoD) of <25,000 CFU/mL and <5,000 CFU/mL in bacteria and fungi, respectively. Discordant results were reconciled with additional testing by target-specific qPCR or 16S Sanger sequencing; 87% of the NGS results were ultimately determined to be the correct result. Overall, these data demonstrate that BIOTIA-ID is a highly accurate clinical-grade diagnostic tool with notable advantages over current culture-based diagnostics

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Do Mixed-Flora Preoperative Urine Cultures Matter?

Abstract: In women with mixed-flora compared with no-growth preoperative urine cultures, there were no differences in the prevalence of postoperative UTI. The clinical practice of interpreting mixed-flora cultures as negative is appropriate.

Cited by 7 publications

References 13 publications

Infección comunitaria del tracto urinario por Escherichia coli en la era de resistencia antibiótica en Ecuador

Infección comunitaria del tracto urinario por Escherichia coli en la era de resistencia antibiótica en Ecuador

Investigating risk factors for urine culture contamination in outpatient clinics: A new avenue for diagnostic stewardship

Analytical Validation of a Highly Accurate and Reliable Next-Generation Sequencing-Based Urine Assay

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