Tag Archives: uti

“A simple approach to uncomplicated UTI”

Confessions of a Microbiologist, The Art of Microbiology, , ,

We have a “no clinical details-no test” policy at my lab, so in general, we get accompanying clinical details with the vast majority of samples received for microbiology testing. After all, at the end of the day, clinicians just want their requests processed…

This is great, but it always irritates me slightly when we get a urine sample into the laboratory from a young adult female with symptoms of a straightforward cystitis with no supporting clinical information to suggest that a “complicated UTI” is being queried.

My first reaction when seeing this is “Why are you sending this urine sample to the lab? Do you think this is going to help your patient?”

In New Zealand, and I suspect most of the rest of the world, uncomplicated UTIs are treated empirically according to local antibiograms, usually with a short course of nitrofurantoin or trimethoprim. In most cases, this settles things down, and no further medical input is required.

We receive approximately 400 urine samples for microbiology processing into our lab each day. My rough estimate is that 5-10% of these urines have clinical details that suggest an uncomplicated UTI. It doesn’t sound much, but it certainly adds up over the course of a year, and the total cost of processing all these would likely cover a scientist’s salary.

...And if we received urine cultures into the lab on every uncomplicated UTI diagnosis, then we would be completely overwhelmed!

During the early stages of the COVID pandemic, when we were getting hammered by SARS-CoV-2 PCR requests, we urged clinicians to send us critical samples only. This certainly reduced the number of requests where the clinical details suggested uncomplicated UTI. But old habits die hard, and now we are more or less back to baseline.

I have often wondered whether we should only accept urines where the clinical details are suggestive of a complicated UTI, but we have not gone there yet. Some might wonder if such an approach is too “hardline”, but it remains an option and I think a very reasonable one at that.

People sometimes think diagnostic stewardship is all about optimising the use of very expensive laboratory tests, e.g multiplex PCR assays, but in actual fact, looking after less costly but higher volume tests such as urine culture is every bit as important…

Michael

“What is acceptable? Any Clinical Details?/Appropriate Clinical details?”

Confessions of a Microbiologist, ,

I have been thinking a lot about clinical details and urine samples, usually in the middle of the night, when sadly, I do most of my thinking.

So what are “acceptable” Clinical Details for urine samples coming into the laboratory?

Clinical details on urine samples can sometimes be basic, very basic… (all of these listed below can be seen written on request forms from urine samples. Such requests will come into most clinical microbiology laboratories worldwide on a regular basis)

  • “?UTI”
  • “Follow up urine post treatment, asymptomatic”
  • “Positive dipstick”
  • “Fatigue 6 months”
  • “MSU”
  • “Smelly urine in catheter bag”
  • “Chest pain”
  • “Exclude infection”
  • “Cloudy urine catheter bag”
  • “Weight loss”

If clinical details were pre-requisite for urine samples, which of the above list would you consider as “appropriate”.

What clinical details one would regard as appropriate is always a little subjective in nature. Therefore my “acceptable” list might be different than yours…..

Insisting on (any) clinical details as a pre-requisite for testing is one thing, and is of course a start. Asking for appropriate clinical details takes the whole process to another level altogether….

It is a difficult area to navigate, but one that we should not avoid because of this.

Michael

If you were taking a tough line on what clinical details are appropriate to justify and optimise microbiology testing of the sample, none of the examples in the above list make it in my book…..