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Bacteriology

Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection

Sanchutha Sathiananthamoorthy, James Malone-Lee, Kiren Gill, Anna Tymon, Trang K. Nguyen, Shradha Gurung, Linda Collins, Anthony S. Kupelian, Sheela Swamy, Rajvinder Khasriya, David A. Spratt, Jennifer L. Rohn
Erik Munson, Editor
Sanchutha Sathiananthamoorthy
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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James Malone-Lee
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Kiren Gill
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Anna Tymon
EDI Department of Microbial Diseases, University College London, London, United Kingdom
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Trang K. Nguyen
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Shradha Gurung
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Linda Collins
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Anthony S. Kupelian
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Sheela Swamy
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Rajvinder Khasriya
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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David A. Spratt
EDI Department of Microbial Diseases, University College London, London, United Kingdom
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Jennifer L. Rohn
Centre for Nephrology, Division of Medicine, University College London, London, United Kingdom
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Erik Munson
Marquette University
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DOI: 10.1128/JCM.01452-18
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ABSTRACT

Midstream urine (MSU) culture 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 cutoff on MSU culture may still harbor bacterial infection and that their antibiotic treatment was associated with symptom resolution. Here, we evaluated the results of the United Kingdom’s MSU culture in symptomatic patients and controls. Next, we compared the bacterial enrichment capabilities of the MSU culture with those of 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, 48.7 years; standard deviation [SD], 16.5 years), 30 LUTS patients on treatment (mean age, 47.8 years; SD, 16.5 years) whose symptoms had relapsed, and 29 asymptomatic controls (mean age, 40.7 years, SD, 15.7 years). 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 recognized 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 United Kingdom’s MSU protocol misses a significant proportion of bacteria, which include recognized uropathogens, and may be unsuitable for excluding UTI in patients with LUTS.

FOOTNOTES

    • Received 7 September 2018.
    • Returned for modification 6 October 2018.
    • Accepted 5 December 2018.
    • Accepted manuscript posted online 12 December 2018.
  • Supplemental material for this article may be found at https://doi.org/10.1128/JCM.01452-18.

  • Copyright © 2019 Sathiananthamoorthy et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

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Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection
Sanchutha Sathiananthamoorthy, James Malone-Lee, Kiren Gill, Anna Tymon, Trang K. Nguyen, Shradha Gurung, Linda Collins, Anthony S. Kupelian, Sheela Swamy, Rajvinder Khasriya, David A. Spratt, Jennifer L. Rohn
Journal of Clinical Microbiology Feb 2019, 57 (3) e01452-18; DOI: 10.1128/JCM.01452-18

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Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection
Sanchutha Sathiananthamoorthy, James Malone-Lee, Kiren Gill, Anna Tymon, Trang K. Nguyen, Shradha Gurung, Linda Collins, Anthony S. Kupelian, Sheela Swamy, Rajvinder Khasriya, David A. Spratt, Jennifer L. Rohn
Journal of Clinical Microbiology Feb 2019, 57 (3) e01452-18; DOI: 10.1128/JCM.01452-18
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KEYWORDS

16S rRNA gene sequencing
lower urinary tract symptoms
midstream urine culture
mixed growth
urinary tract infection

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