Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection
| Autor: | Linda M. Collins, Anna Tymon, David A. Spratt, Trang K. Nguyen, James Malone-Lee, Sheela Swamy, Kiren Gill, Rajvinder Khasriya, Jennifer L. Rohn, Sanchutha Sathiananthamoorthy, Anthony Kupelian, Shradha Gurung |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 0301 basic medicine Microbiology (medical) medicine.medical_specialty Adolescent medicine.drug_class Urinary system 030106 microbiology Antibiotics Urine Urinalysis urologic and male genital diseases Asymptomatic Young Adult 03 medical and health sciences nursing Lower urinary tract symptoms Internal medicine medicine Humans In patient lower urinary tract symptoms 16S rRNA gene sequencing Aged Bacteriological Techniques business.industry Bacteriology Gold standard (test) Middle Aged medicine.disease female genital diseases and pregnancy complications midstream urine culture 030104 developmental biology Urinary Tract Infections 16s rrna gene sequencing Female medicine.symptom urinary tract infection business biological mixed growth |
| Zdroj: | Journal of Clinical Microbiology |
| ISSN: | 1098-660X 0095-1137 |
| DOI: | 10.1128/jcm.01452-18 |
| Popis: | 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. 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. |
| Databáze: | OpenAIRE |
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