Outpatient Urine Culture

Lifshitz, Edward; Kramer, Liane

doi:10.1001/archinte.160.16.2537

Cited by 157 publications

(25 citation statements)

References 19 publications

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“…The difficulties in getting a genuine “clean-catch” MSU sample representative of only organisms originating from the bladder is well-recognized and especially so for females, in which the urine has to pass through the distal urethra and/or for the elderly (both male and female), who have physical or other impairments (Franz and Hörl, 1999; Lifshitz and Kramer, 2000; Wilson and Gaido, 2004). Nonetheless, it is less intrusive than alternative approaches, such as bladder tissue biopsy or catheterization, and hence the most pragmatic and ethical approach for larger, longitudinal studies and clinical application and it was therefore our positive intention to collect samples in this way (Wolfe et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

The human urinary microbiome; bacterial DNA in voided urine of asymptomatic adults

Lewis¹,

Brown²,

Williams³

et al. 2013

Front. Cell. Infect. Microbiol.

319

290

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The urinary microbiome of healthy individuals and the way it alters with ageing have not been characterized and may influence disease processes. Conventional microbiological methods have limited scope to capture the full spectrum of urinary bacterial species. We studied the urinary microbiota from a population of healthy individuals, ranging from 26 to 90 years of age, by amplification of the 16S rRNA gene, with resulting amplicons analyzed by 454 pyrosequencing. Mid-stream urine (MSU) was collected by the “clean-catch” method. Quantitative PCR of 16S rRNA genes in urine samples, allowed relative enumeration of the bacterial loads. Analysis of the samples indicates that females had a more heterogeneous mix of bacterial genera compared to the male samples and generally had representative members of the phyla Actinobacteria and Bacteroidetes. Analysis of the data leads us to conclude that a “core” urinary microbiome could potentially exist, when samples are grouped by age with fluctuation in abundance between age groups. The study also revealed age-specific genera Jonquetella, Parvimonas, Proteiniphilum, and Saccharofermentans. In conclusion, conventional microbiological methods are inadequate to fully identify around two-thirds of the bacteria identified in this study. Whilst this proof-of-principle study has limitations due to the sample size, the discoveries evident in this sample data are strongly suggestive that a larger study on the urinary microbiome should be encouraged and that the identification of specific genera at particular ages may be relevant to pathogenesis of clinical conditions.

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Section: Discussionmentioning

confidence: 99%

The human urinary microbiome; bacterial DNA in voided urine of asymptomatic adults

Lewis¹,

Brown²,

Williams³

et al. 2013

Front. Cell. Infect. Microbiol.

319

290

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show abstract

“…If a clean-catch urine specimen is challenging for a patient to obtain (eg, obesity, arthritis), a simple voided specimen, although less ideal, can be used. 39 …”

Section: The Evidence: Diagnosis Management and Preventionmentioning

confidence: 99%

Urinary Tract Infections in Older Women

Mody

Juthani‐Mehta

2014

JAMA

289

170

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IMPORTANCE Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. OBJECTIVE To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women. EVIDENCE REVIEW A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. RESULTS The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs. CONCLUSIONS AND RELEVANCE Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.

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“…While no significant differences were observed between first-void and midstream urine in males, there are significant variations in female first-void urine compared with midstream urine, probably due to bacterial contamination (Schaub et al, 2004). Other studies showed that approximately 40% of bacterial contamination in female urine samples derived from the skin contamination (Finkel, 2006;Lifshitz and Kramer, 2000). However, by using a prostatic fluid indicative panel, Theodorescu et al (2008) discovered a panel of 12 novel prostate cancer (PCa) biomarkers in the first-void urine, in addition to collection of sufficient amounts of prostatic fluid.…”

Section: Sample Collection: First-void or Midstream Urine?mentioning

confidence: 89%

Urinary proteomics as a novel tool for biomarker discovery in kidney diseases

Chen

2010

J. Zhejiang Univ. Sci. B

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Urine has become one of the most attractive biofluids in clinical proteomics, for its procurement is easy and noninvasive and it contains sufficient proteins and peptides. Urinary proteomics has thus rapidly developed and has been extensively applied to biomarker discovery in clinical diseases, especially kidney diseases. In this review, we discuss two important aspects of urinary proteomics in detail, namely, sample preparation and proteomic technologies. In addition, data mining in urinary proteomics is also briefly introduced. At last, we present several successful examples on the application of urinary proteomics for biomarker discovery in kidney diseases, including diabetic nephropathy, IgA nephropathy, lupus nephritis, renal Fanconi syndrome, acute kidney injury, and renal allograft rejection.

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Outpatient Urine Culture

Cited by 157 publications

References 19 publications

The human urinary microbiome; bacterial DNA in voided urine of asymptomatic adults

The human urinary microbiome; bacterial DNA in voided urine of asymptomatic adults

Urinary Tract Infections in Older Women

Urinary proteomics as a novel tool for biomarker discovery in kidney diseases

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