Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection.

Autor:	Sathiananthamoorthy S; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom rebmssa@ucl.ac.uk j.rohn@ucl.ac.uk., Malone-Lee J; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Gill K; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Tymon A; EDI Department of Microbial Diseases, University College London, London, United Kingdom., Nguyen TK; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Gurung S; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Collins L; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Kupelian AS; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Swamy S; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Khasriya R; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom., Spratt DA; EDI Department of Microbial Diseases, University College London, London, United Kingdom., Rohn JL; Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom rebmssa@ucl.ac.uk j.rohn@ucl.ac.uk.
Jazyk:	angličtina
Zdroj:	Journal of clinical microbiology [J Clin Microbiol] 2019 Feb 27; Vol. 57 (3). Date of Electronic Publication: 2019 Feb 27 (Print Publication: 2019).
DOI:	10.1128/JCM.01452-18
Abstrakt:	Midstream urine (MSU) culture remains the gold standard diagnostic test for confirming urinary tract infection (UTI). We previously showed that patients with chronic lower urinary tract symptoms (LUTS) below the diagnostic cutoff on MSU culture may still harbor bacterial infection and that their antibiotic treatment was associated with symptom resolution. Here, we evaluated the results of the United Kingdom's MSU culture in symptomatic patients and controls. Next, we compared the bacterial enrichment capabilities of the MSU culture with those of a 50-µl uncentrifuged culture, a 30-ml centrifuged sediment culture, and 16S rRNA gene sequencing. This study was conducted on urine specimens from 33 LUTS patients attending their first clinical appointment (mean age, 48.7 years; standard deviation [SD], 16.5 years), 30 LUTS patients on treatment (mean age, 47.8 years; SD, 16.5 years) whose symptoms had relapsed, and 29 asymptomatic controls (mean age, 40.7 years, SD, 15.7 years). We showed that the routine MSU culture, adopting the UK interpretation criteria tailored to acute UTI, failed to detect a variety of bacterial species, including recognized uropathogens. Moreover, the diagnostic MSU culture was unable to discriminate between patients and controls. In contrast, genomic analysis of urine enriched by centrifugation discriminated between the groups, generating a more accurate understanding of species richness. In conclusion, the United Kingdom's MSU protocol misses a significant proportion of bacteria, which include recognized uropathogens, and may be unsuitable for excluding UTI in patients with LUTS. (Copyright © 2019 Sathiananthamoorthy et al.)
Databáze:	MEDLINE
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