Urine sampling techniques in symptomatic primary-care patients: a diagnostic accuracy review

Abstract

BackgroundChoice of urine sampling technique in urinary tract infection may impact diagnostic accuracy and thus lead to possible over- or undertreatment. Currently no evidencebased consensus exists regarding correct sampling technique of urine from women with symptoms of urinary tract infection in primary care. The aim of this study was to determine the accuracy of urine culture from different sampling-techniques in symptomatic non-pregnant women in primary care.MethodsA systematic review was conducted by searching Medline and Embase for clinical studies conducted in primary care using a randomized or paired design to compare the result of urine culture obtained with two or more collection techniques in adult, female, non-pregnant patients with symptoms of urinary tract infection. We evaluated quality of the studies and compared accuracy based on dichotomized outcomes.ResultsWe included seven studies investigating urine sampling technique in 1062 symptomatic patients in primary care. Mid-stream-clean-catch had a positive predictive value of 0.79 to 0.95 and a negative predictive value close to 1 compared to sterile techniques. Two randomized controlled trials found no difference in infection rate between mid-stream-clean-catch, mid-stream-urine and random samples.ConclusionsAt present, no evidence suggests that sampling technique affects the accuracy of the microbiological diagnosis in non-pregnant women with symptoms of urinary tract infection in primary care. However, the evidence presented is in-direct and the difference between mid-stream-clean-catch, mid-stream-urine and random samples remains to be investigated in a paired design to verify the present findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0465-4) contains supplementary material, which is available to authorized users.

Urinary incontinence in women

“…Urine reagent dipsticks have a low sensitivity and high specificity for the exclusion and identification of UTIs 77 · 78 , respectively. Formal microscopy, culture and antibiotic sensitivity (MCS) analyses of a clean-catch urine specimen or catheter urine specimen are recommended 79 in women who have symptoms of UTI or have a positive dipstick 63 .…”

Anthocyanins in Blueberries Grown in Hot Climate Exert Strong Antioxidant Activity and May Be Effective against Urinary Tract Bacteria

“…Urine was collected from 6 human patients who had given their written consent, in accordance with the ethics protocol of the collecting hospital, the County Emergency Hospital Cluj-Napoca, Romania (SCJU). The inclusion criteria were age above 18 years and the presence of clear clinical signs of UTI: hypogastric pain or/and dysuria or/and pollakiuria or/and disturbed urine or/and renal colic [ 66 ]. The exclusion criteria were antibiotic treatments 48 h previous to sampling and absence of leucocytes and/or of nitrites on dipstick analysis [ 66 ].…”

Utility of catheterized specimens in reducing overdiagnosis of urinary tract infections in women

“…Past studies have shown mixed results when comparing clean catch and catheterized specimens. A systematic review article found that the lower specificity of voided samples would cause 5‐10% of patients to be overdiagnosed . In our study, we found that less than half of our cohort had a positive catheterized specimen despite having a positive clean catch.…”

“…In addition to infection, bacteriuria can be due to colonization of the urine or to bacterial contamination of the specimen . There are multiple methods for collecting a urine specimen including: mid‐stream clean catch, mid‐stream urine without cleaning, random sample without instructions, catheterized specimen, or suprapubic aspiration . There is concern that contamination from urethral and vaginal flora can impair the diagnostic reliability of a clean catch sample …”