Pemeriksaan Bakteriologik Urin

Lab. Mikrobiologi FK Universitas YARSI

Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas

When is urine culture helpful? Urine culture should be performed for:

1. 2. 3. 4. 5.

Women with a UTI with complicating features All pregnant women Men with suspected UTI Suspected acute pyelonephritis Prostatitis

Complicating features in women include: Abnormal urinary tract e.g. stone, reflux, catheter Impaired host defences e.g. pregnancy, diabetes, immunosupression, Impaired renal function, Suspicion of pyelonephritis, More than three UTIs in one year, or UTI recurrence within two weeks.

Urine culture is recommended for pregnant women

Women with asymptomatic bacteriuria in early pregnancy have a 20-30 fold increased risk of developing pyelonephritis, premature delivery and low birth weight infants. All pregnant women should be screened for asymptomatic bacteriuria at 12-16 weeks gestation.
If bacteriuria is detected by screening, the patient should be treated and a urine culture performed monthly throughout the pregnancy

Urine culture is indicated for lower UTI in Men

All UTIs in men are considered complicated, therefore a urine culture is indicated, even if the urine dipstick is negative.

A urine culture is indicated when acute pyelonephritis is suspected

Dipstick testing of the urine may be useful if clinical findings are equivocal Antibiotics should be commenced while waiting for culture results

Post-treatment urine cultures are recommended one to two weeks after antibiotic therapy

Acute Prostatitis

Signs and symptoms of acute prostatitis include fever, dysuria, pelvic or perineal pain, and cloudy urine Urine culture should be performed If urine culture is negative, STIs (C. trachomatis, N. gonorrhoea) should be excluded.

Chronic Prostatitis

Chronic prostatitis should be considered in men with dysuria and frequency, no signs of acute prostatitis, and with recurrent UTIs. Gram-negative bacilli are most common cause, but enterococci and Chlamydia have been associated with chronic infection.

Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas

Sampling

Urine - General
Collection method must avoid contamination
Clean catch, midstream voided Catheterized urine Suprapubic aspiration

Cultures performed quantitatively

Less than 10,000 per ml suggest contamination

Clean Catch, Midstream Urine

Cleanse periurethral area with soap and water Pass initial urine into toilet, then collect specimen in cup Instructions to patient are critical

Pre specimen processing

Patient prepartion
Instruct the procedures for the patient Specimen collection Collection of midstream urine for bacterial investigation: Patient not needing assistance: Give the patient a suitable container. Instruct the patient before the collection, preferably with illustration. Tell the patient not to touch the inside or rim of the container.

Pre specimen processing

Who will collect the specimen
Midstream urine is collected by the patient. If disabled, nursing staff will assist in collection. For catheterized specimen, nursing staff will collect the specimen. Suprapubic aspiration is performed by the physician.

Quantity of specimen
To fill line in transport tube (~20 mL).

Time relapse before processing the sample

The maximum time allowed for processing a urine sample is 2 hours from the time of collection. Suprapubic aspiration

Storage
At room temperature unless delay is inevitable; it must be refrigerate or mixed with preservative like boric acid.

Instructions for Patient

1. 2. 3. 4. Remove underpants completely so they will not get soiled. Sit comfortably on the seat, but do not leave your knees in front of you. Instead swing one knee to the side as far as you can. Spread yourself with one hand, and continue to hold yourself spread while you clean and collect the specimen. WashBe sure you wash well and rinse well before you collect your urine sample. Wash only the area from which you pass urine. You do not have to wash hard, but wash slowly. Be sure to wipe from the front of your body towards the back. Wash between the folds of skin as carefully as you can. Do not put sponges in the toilet. Put them back in the plate. RinseAfter you have washed with each soap pad, rinse with each moistened pad with the same front to back motion. Do not use any pad more than once. Hold cup by the outside and pass your urine into the cup. If you touch the inside of the cup or drop it on the floor, ask the nurse to give you a new one.

5. 6.
7.

Sample Collection (supra pubic puncture)

Sample collection (in situ cathether)

Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas

Specimen processing

Initial report

The use of dipstick designed to detect the presence of urine nitrite and to indirectly estimate the number of segmented neutrophiles through the detection of leukocyte esterase activity. Rationale for the nitrate test is that most urinary tract infections are caused by nitrate reducing members of the family Enterobacteriaceae.
Leukocyte esterase (LE) is produced by segmented nutrophiles; this test when performed alone correlated with ten or more white blood cells per high power field in the urine with a sensitivity in the range 88% and specificity 94%.

Pyuria

 Pyuria: the increased number of WBC in urine sample. sterile pyuria: is a condition arises when there is an elevated in WBC in urine and negative culture.

Screening test

As many as 60% to 80% of all urine specimens received for culture by the acute care medical Center laboratory may contain no etiological agents of infection. Procedure developed to identify quickly those urine specimens that will be negative on culture, thus to circumvent excessive use of media, technologist time, and the overnight incubation period. The gram stain is the easiest, least expensive, and probably the most sensitive and reliable screening method for identifying urine specimens that contain greater than 10^5 CFU/ml. A drop of well-mixed urine is allowed to air dry. The smear is stained and examined under oil immersion (1000x). Presence of at least one organism per oil immersion field. ( examining 20 fields ) corelates with significant bacteriuria (>10^5 CFU/ml).

Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas

Culturing Procedure
Mix the urine sample to re-suspend microorganism present. Dip a 1 l or 10 l calibrated loop in vertical position in the urine and remove the loop and use the collected fluid to inoculate Nutrient, Blood and MacConkey agars respectively.

Culturing Procedure

Colony counting

CFU # colonies counted in original sample ml (dilution) (volume plated, in ml)

A plate count of 100,000 CFU/ml of pure culture should be considered positive and isolated organism should be identified and sensitivity test will be performed. A plate count between 10,000 100,000 CFU/ml is considered suspected . A plate count less than 10,000 CFU/ml is considered negative.

Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas

Metode kultur baru

Bacturcult Urine Culture Tube

Conventional Urine Dipslides

No of colonies: up to 3

4 - 10

11 - 20

21 -50

over 50

UTI-SET SYSTEM

NOVAmed Ltd

DipStreak

Interpretation

Interpretation of Quantitative Culture