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Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection

Sathiananthamoorthy, S; Malone-Lee, J; Gill, K; Tymon, A; Nguyen, TK; Gurung, S; Collins, L; ... Rohn, JL; + view all (2018) Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection. Journal of Clinical Microbiology 10.1128/JCM.01452-18. Green open access

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Abstract

Midstream urine culture (MSU) 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 cut-off on MSU culture may still harbour bacterial infection, and that their antibiotic treatment was associated with symptom resolution. Here, we evaluated the results of the UK's MSU culture in symptomatic patients and controls. Next, we compared the bacterial enrichment capabilities of the MSU culture with 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 = 49 years, standard deviation [SD] = 16.5), 30 LUTS patients on treatment (mean age = 47.8 years, SD = 16.8) whose symptoms had relapsed, and 29 asymptomatic controls (mean age = 40.7 years, SD = 15.7). 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 recognised 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 UK's MSU protocol misses a significant proportion of bacteria, which include recognised uropathogens, and may be unsuitable for excluding UTI in patients with LUTS.

Type: Article
Title: Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1128/JCM.01452-18
Publisher version: https://doi.org/10.1128/JCM.01452-18
Language: English
Additional information: Copyright © 2018 Sathiananthamoorthy et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.
Keywords: Midstream urine culture, Urinary tract infection, Lower urinary tract symptoms, Mixed growth, 16S rRNA gene sequencing
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute > Microbial Diseases
URI: https://discovery.ucl.ac.uk/id/eprint/10064295
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