Urine culture processing and results

All urine culture testing is performed using manual methods. The culture pathway adheres to national guidance and is a fully UKAS-accredited method.

Manual testing allows a larger amount of urine to be tested than previous automated method, which enables the laboratory to detect lower bacterial counts (as low as 103 cfu/mL) and also facilitates the follow up of significant organisms grown from mixed cultures.

If the culture result is indicative of urinary tract infection, antibiotic susceptibilities will be tested from the culture growth and will be available 24 hours after the culture result. ‘Direct sensitivities’ are no longer performed. Direct susceptibility testing is not inoculum-controlled, produces inaccurate results and is not UKAS-accredited.

Culture results should be interpreted alongside the microscopy WBC count and clinical signs and symptoms. Significant growth on culture in the absence of pyuria may be suggestive of contamination with regional flora rather than true infection. It should be noted, however, that WBC degrade in urine quite rapidly and delays between sample collection and microscopy may lead to falsely low WBC readings which may account for these findings.

 

What does the result ‘No significant growth’ mean?

The amount of growth falls below the threshold for urinary tract infection (< 103 cfu/mL).

There is no laboratory evidence of urinary tract infection.

Occasionally, this may be seen in very early stages of infection or in a partially treated urinary tract infection. Therefore, please send a repeat specimen if symptoms persist.

 

What does the result ‘mixed growth doubtful significance’ mean?

This means that the culture revealed a heavy growth of at least 3 organisms with no predominating organism; this represents contamination of the urine with the patient’s flora during collection.

This result does not exclude urinary tract infection but it is not possible to determine the causative organism among the mixture of organisms.

If symptoms persist, please send a repeat urine specimen and ensure that patient understands optimal collection technique.

If you are receiving a lot of ‘mixed growth of doubtful significance’ results, please consider the following:
 

  • The instructions that patients are given to collect their urine sample
    Poor collection technique is the most common reason for a heavily mixed growth in a urine sample. It is almost impossible to collect a urine sample without any contamination from the normal bacterial flora which inhabits the area surrounding the urethral opening, but optimal collection technique will minimise this contamination and allow the true infective cause to stand out and be identified (a patient instruction leaflet is available).
     
  • Delays between sample collection and laboratory processing
    The time between sample collection and laboratory processing can allow small amounts of contaminating bacterial flora to multiply up to higher amounts prior to laboratory testing, which can result in heavy mixed growth of bacteria on culture.  Using a red topped specimen pot containing boric acid preservative will minimise this. 
     

Red topped boric acid containers

The preservative reduces the overgrowth of organisms and, to a lesser extent, reduces the degradation of white cells during transit leading to a more accurate laboratory result for both microscopy and culture. UKAS recommends the use of boric acid containers for all urine sample for microscopy and culture (Urine M,C&S) to improve the quality of microbiological results. 

Red topped boric acid containers are for requests for urine microscopy and culture (MC&S) ONLY. Boric acid container should NOT be used for: 

  • Other urine microbiology tests (e.g. investigations for Chlamydia, Mycobacterium, Schistosomiasis, urinary antigen testing)
  • Urine samples being analysed by PCR methodology
  • Urine samples for non-microbiology tests (e.g. biochemistry, virology, pregnancy testing)
  • Very small urine volumes (<20ml) e.g. neonates

Use of urinary dipsticks: boric acid may inhibit leukocyte esterase dipstick readings; dipstick testing performed on a sample in a boric acid container should be interpreted with caution.

If additional tests are required in addition to urine microscopy and culture, an additional sample in a white-topped universal container should be sent. In this case, it is advised that the mid-stream clean catch urine is collected in a sterile bowl and then transferred to the necessary specimen containers.

 

If, despite these measures, a patient has recurrent mixed growth reports from multiple urines, it may suggest that your patient has abnormal urinary tract architecture, immunosuppression or other non-infective cause that requires different laboratory investigations or referral to a specialist. If further information is required, please telephone the laboratory and ask to discuss the case with one of our consultant Microbiologists.