Reflex testing of male urine specimens misses few positive cultures may reduce unnecessary testing of normal specimens

Urology
Cynthia FokPaul Schreckenberger

Abstract

To determine the predictive values of leukocyte count for the presence of a positive urine culture in ambulatory male urology patients. Many institutions have adopted a practice of "reflex testing" urine samples, in which urine culture is only performed if a threshold number of leukocytes (WBCs [white blood cells]) is present. We performed a retrospective chart review of all male patients who presented to our tertiary-care urology clinic in 2006. Only those with both a urinalysis and urine culture performed were included in this study. A urine culture was considered positive if at least 10,000 colonies of a uropathogen were present. Data were tabulated and analyzed using SPSS V15.0 software. Of 874 patients, 176 (20%) urine cultures were positive. WBCs were present at a concentration of at least 5/hpf (high power field) in 367 (42%) of all specimens and in 163 of 176 (93%) positive specimens, but were present at lower concentrations in 13 specimens with positive cultures. The presence of >5 WBC/hpf had a positive predictive value of 47%, and a negative predictive value of 97% for positive culture. Reflex urine testing, in which cultures are done on urine specimens with >5 WBC/hpf, would have missed 7% of positive urine cultures...Continue Reading

References

Jul 28, 1983·The American Journal of Medicine·W E Stamm
Jul 1, 1995·British Journal of Urology·D NunnsG Hosker

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Citations

Oct 30, 2012·Diagnostic Microbiology and Infectious Disease·Mark PartaCharles Stager
Sep 18, 2018·International Journal of Urology : Official Journal of the Japanese Urological Association·Kyle A RichardsNasia Safdar
Aug 11, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jennifer A FronteraJoseph Weisstuch
Jul 1, 2020·The Journal of Applied Laboratory Medicine·Allison B ChamblissTam T Van
Oct 5, 2020·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·Mohammad OuraniJill Roberts
Jul 8, 2020·American Journal of Infection Control·Dorothy LingSonali Advani
Dec 10, 2019·American Journal of Infection Control·David F DoughertyThomas R Talbot

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