Urine culture what technique
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Taking urine culture is very important in order to make right diagnosis of urinary tract infection, correct decision and make a logic follow up for children and infants
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Urine culture what technique
- 1. Urine Culture - What technique? Hooman N Professor Consultant Pediatric Nephrology IUMS 2016
- 4. Scenario 1 • 25 days newborn - girl • with mild jaundice • PE- NL • UC with sterile bag: – klebsiella spp. >100000 – Sensitive : imipenem, Amikacin, Ciprofluxacillin • What do you do?
- 5. Aim • Recommended UC Technique • Advantage /disadvantage • Cut-off level of bacteriuria
- 7. UA/UC interpretation depends on Symptoms UA UC Asymptomatic / Symptomatic- not ill/ill Nl / active Neg./ Pos •PH?/ Medication •PhEx (Genital exam) •Technique of Urine sample taken
- 8. Urine culture techniques • Non-invasive – Sterile bag – Clean catch midstream – Urine collection by bladder stimulation technique • Invasive – U-CATH – SPA
- 9. Urine collection by bladder stimulation technique
- 13. Accuracy of Different Techniques
- 14. Urine collection method in non-toilet trained children Guidelines SPA U-CATH Clean catch Sterile Bag NICE 2nd option - 1st choice No AAP 1st choice - Not considered No ISPN Not considered In case of bad clinical conditions 1st choice 2nd choice good clinical condition
- 15. Success rate • Non-invasive – Sterile bag: – Clean catch-stimulation: 78- 86.3% • ( median time:45”-60”) • Invasive – U-CATH: 72-100% – SPA: 20-90%
- 16. Urine bag • Contamination rate : 63%- 88% • False Positive: 7.5% • False Negative: 29% • Misdiagnosis: 40% DOI: http://dx.doi.org/10.1016/j.jpeds.2009.01.008
- 17. • Importance? For Unnecessary – Recall, infinite for delayed diagnosis and treatment, AOR(95%CI): 4.9 (2.3 to 10.5) – Treatment, 4.8 (1.8 to 12.4) – Prolonged treatment, 15.6 (2.1 to 116.8) – Radiologic investigation, 4.1 (1.4 to 12.1) – Hospital admission. 12.4 (1.6 to 95.5) Al-Orifi F. et al,The Journal of pediatrics. DOI: http://dx.doi.org/10.1067/mpd.2000.107466 www.pediatrics.org/cgi/ doi/10.1542/peds.2011-1818
- 19. Recommendation Cut-off levels of Bacteriuria
- 20. • 430 , < 1 yr, Symptomatic UTI by SPA • VCUG, DMSA, F/U for RUTI • Groups: – 19% < 100000 CFU/ml , – 81% > 100000 CFU/ml
- 21. • SPA preferred method in non-toilet trained • If Culture obtained by sterile bag, and the culture is positive, the result must be confirmed by a more accurate alternative technique. • Before initiating antibiotic Take Home Message
Editor's Notes
- The first step is either breast-feeding or providing formula intake appropriate to the age and weight of the newborn. If the baby is nil by mouth, discuss if the baby is well enough for this technique with the medical team and make sure the baby has not recently had a wet nappy. Consider imaging by ultrasound to check if the bladder is full. Twenty-five minutes after feeding, the infant’s genitals should be cleaned with antiseptic solution (esp. important if collection is for microbiology).3Consider to give sucrose 0.2 ml if the baby is >1,500 g and > 31 weeks’ CGA4One person holds the baby under the armpits with their legs dangling and lower body undressed A second person then starts the bladder stimulation, which consists of a gentle tapping in the suprapubic area at a frequency of 100 taps or blows per minute for 30 s.
- The next step is stimulation of the lumbar paravertebral zone in the lower back with a light circular massage for 30 s.