Revisiting approaches to and considerations for urinalysis and urine culture reflexive testing

References

• Armstrong JA. Urinalysis in Western culture: a brief history. Kidney Int. 2007;71(5):384–387.
   PubMed Web of Science ®Google Scholar
• Simerville JA, Maxted WC, Pahira JJ. Urinalysis: a comprehensive review. Am Fam Physician. 2005;71(6):1153–1162.
   PubMed Web of Science ®Google Scholar
• Peele JD, Gadsden RH, Crews R. Semi-automated vs. visual reading of urinalysis dipsticks. Clin Chem. 1977;23(12):2242–2246.
   PubMed Web of Science ®Google Scholar
• Arboleda VA, Garner OB. Ensuring the quality of point-of-care testing in a large and decentralized ambulatory care setting. Am J Clin Pathol. 2017;148(4):336–344.
   PubMed Web of Science ®Google Scholar
• Block DR, Lieske JC. Automated urinalysis in the clinical lab. MLO Med Lab Obs. 2012;44(10):8–10. 12.
   PubMedGoogle Scholar
• Shayanfar N, Tobler U, von Eckardstein A, et al. Automated urinalysis: first experiences and a comparison between the iris iQ200 urine microscopy system, the sysmex UF-100 flow cytometer and manual microscopic particle counting. Clin Chem Lab Med. 2007;45(9):1251–1256.
   PubMed Web of Science ®Google Scholar
• Gai M, Piccoli GB, Segoloni GP, et al. Microscopic urinalysis and automated flow cytometry in a nephrology laboratory. Clin Chem. 2003;49(9):1559–1560.
   PubMed Web of Science ®Google Scholar
• Tworek JA, Wilkinson DS, Walsh MK. The rate of manual microscopic examination of urine sediment: a college of American pathologists Q-Probes study of 11,243 urinalysis tests from 88 institutions. Arch Pathol Lab Med. 2008;132(12):1868–1873.
   PubMed Web of Science ®Google Scholar
• Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the infectious diseases society of America. Clin Infect Dis. 2019;68(10):e83–e110.
   PubMed Web of Science ®Google Scholar
• Morrison MC, Lum G. Dipstick testing of urine-can it replace urine microscopy? Am J Clin Pathol. 1986;85(5):590–594.
   PubMed Web of Science ®Google Scholar
• Heimann GA, Frohlich J, Bernstein M. Physicians’ response to abnormal results of routine urinalysis. Can Med Assoc J. 1976;115(11):1094–1095.
   PubMed Web of Science ®Google Scholar
• O’Kell RT. Microscopic urinalysis as a screening procedure. Am J Clin Pathol. 1979;72(6):1041.2–1042.
   PubMed Web of Science ®Google Scholar
• Benham L, O'Kell RT. Urinalysis: minimizing microscopy. Clin Chem. 1982;28(7):1722.
   PubMed Web of Science ®Google Scholar
• Shaw ST, Poon SY, Wong ET. Routine urinalysis”. Is the dipstick enough? JAMA. 1985;253(11):1596–1600.
   PubMed Web of Science ®Google Scholar
• Multistix 10 SG Reagent Strip package insert, Siemens Healthcare Diagnostics Inc.; 2021.
   Google Scholar
• CLSI. Urinalysis: Approved guideline. – Third Edition. CLSI document GP16. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.
   Google Scholar
• Wenz B, Lampasso JA. Eliminating unnecessary urine microscopy. Results and performance characteristics of an algorithm based on chemical reagent strip testing. Am J Clin Pathol. 1989;92(1):78–81.
   PubMed Web of Science ®Google Scholar
• Christenson RH, Tucker JA, Allen E. Results of dipstick tests, visual inspection, microscopic examination of urine sediment, and microbiological cultures of urine compared for simplifying urinalysis. Clin Chem. 1985;31(3):448–450.
   PubMed Web of Science ®Google Scholar
• Tetrault GA. Automated reagent strip urinalysis: utility in reducing work load of urine microscopy and culture. Lab Med. 1994;25(3):162–167.
   Web of Science ®Google Scholar
• Chambliss AB, Mason HM, Van TT. Correlation of chemical urinalysis to microscopic urinalysis and urine culture: implications for reflex urinalysis workflows. J Appl Lab Med. 2020;5(4):724–731.
   PubMedGoogle Scholar
• Unic A, Nikolac Gabaj N, Miler M, et al. Ascorbic acid-A black hole of urine chemistry screening. J Clin Lab Anal. 2018;32(5):e22390.
   PubMed Web of Science ®Google Scholar
• Ko DH, Jeong TD, Kim S, Chung HJ, et al. Influence of vitamin C on urine dipstick test results. Ann Clin Lab Sci. 2015;45(4):391–395.
   PubMed Web of Science ®Google Scholar
• Masajtis-Zagajewska A, Nowicki M. New markers of urinary tract infection. Clin Chim Acta. 2017;471:286–291.
   PubMed Web of Science ®Google Scholar
• Flores-Mireles AL, Walker JN, Caparon M, et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269–284.
   PubMed Web of Science ®Google Scholar
• Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Therap Adv Urol. 2019;11:175628721983217.
   Web of Science ®Google Scholar
• Subcommittee on Urinary Tract Infection. Reaffirmation of AAP clinical practice guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2–24 months of age. Pediatrics. 2016;138(6):e20163026.
   PubMed Web of Science ®Google Scholar
• Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the infectious diseases society of America. Clin Infect Dis. 2019;68(10):1611–1615.
   PubMedGoogle Scholar
• McCarter YS, Burd EM, Hall GS, et al. Cumitech 2C, laboratory diagnosis of urinary tract infections. Washington (DC): ASM Press; 2009.
   Google Scholar
• Doern CD, Richardson SE. Diagnosis of urinary tract infections in children. J Clin Microbiol. 2016;54(9):2233–2242.
   PubMed Web of Science ®Google Scholar
• Hooton TM, Roberts PL, Cox ME, et al. Voided midstream urine culture and acute cystitis in premenopausal women. N Engl J Med. 2013;369(20):1883–1891.
   PubMed Web of Science ®Google Scholar
• Arav-Boger R, Leibovici L, Danon YL. Urinary tract infections with low and high colony counts in young women: spontaneous remission and single-dose vs multiple-day treatment. Arch Intern Med. 1994;154(3):300–304.
   PubMedGoogle Scholar
• Kunin CM. A reassessment of the importance of low-count bacteriuria in young women with acute urinary symptoms. Ann Intern Med. 1993;119(6):454.
   PubMed Web of Science ®Google Scholar
• Licker M, Sorescu T, Rus M, et al. Extensively drug-resistant Myroides odoratimimus – a case series of urinary tract infections in immunocompromised patients. Infect Drug Resist. 2018;11:743–749.
   PubMed Web of Science ®Google Scholar
• Kanuparthy A, Challa T, Meegada S, et al. Staphylococcus warneri: skin commensal and a rare cause of urinary tract infection. Cureus. 2020;12(5):e8337.
   PubMed Web of Science ®Google Scholar
• Skelton WP, Taylor Z, Hsu J. A rare case of Raoultella planticola urinary tract infection in an immunocompromised patient with multiple myeloma. IDCases. 2017;8:9–11.
   PubMed Web of Science ®Google Scholar
• Leber AL, ed. Clinical microbiology procedures handbook. 4th edition. Washington, DC: ASM Press; 2016.
   Google Scholar
• CDC. Antibiotic Use in the United States, 2018 Update: Progress and Opportunities. Atlanta, GA: US Department of Health and Human Services, CDC; 2019. Available from: https://www.cdc.gov/antibiotic-use/stewardship-report/pdf/stewardship-report-2018-508.pdf
   Google Scholar
• Horstman MJ, Spiegelman A, Naik AD, et al. National patterns of urine testing during inpatient admission. Clin Infect Dis. 2017;65(7):1199–1205.
   PubMed Web of Science ®Google Scholar
• Laan BJ, van Horrik T, Nanayakkara PWB, et al. How many urinalysis and urine cultures are necessary? Eur J Intern Med. 2021;83:58–61.
   PubMed Web of Science ®Google Scholar
• Leis JA, Gold WL, Daneman N, et al. Downstream impact of urine cultures ordered without indication at two acute care teaching hospitals. Infect Control Hosp Epidemiol. 2013;34(10):1113–1114.
   PubMed Web of Science ®Google Scholar
• Hartley S, Valley S, Kuhn L, et al. Inappropriate testing for urinary tract infection in hospitalized patients: an opportunity for improvement. Infect Control Hosp Epidemiol. 2013;34(11):1204–1207.
   PubMed Web of Science ®Google Scholar
• Yin P, Kiss A, Leis JA. Urinalysis orders among patients admitted to the general medicine service. JAMA Intern Med. 2015;175(10):1711–1713.
   PubMed Web of Science ®Google Scholar
• Kiyatkin D, Bessman E, McKenzie R. Impact of antibiotic choices made in the emergency department on appropriateness of antibiotic treatment of urinary tract infections in hospitalized patients: appropriateness of antibiotics for UTIs. J Hosp Med. 2016;11(3):181–184.
   PubMed Web of Science ®Google Scholar
• Cope M, Cevallos ME, Cadle RM, et al. Inappropriate treatment of catheter‐associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis. 2009;48(9):1182–1188.
   PubMed Web of Science ®Google Scholar
• Dalen DM, Zvonar RK, Jessamine PG. An evaluation of the management of asymptomatic catheter-associated bacteriuria and candiduria at the Ottawa hospital. Can J Infect Dis Med Microbiol. 2005;16(3):166–170.
   PubMedGoogle Scholar
• Grein JD, Kahn KL, Eells SJ, et al. Treatment for positive urine cultures in hospitalized adults: a survey of prevalence and risk factors in 3 medical centers. Infect Control Hosp Epidemiol. 2016;37(3):319–326.
   PubMed Web of Science ®Google Scholar
• Petty LA, Vaughn VM, Flanders SA, et al. Risk factors and outcomes associated with treatment of asymptomatic bacteriuria in hospitalized patients. JAMA Intern Med. 2019;179(11):1519–1527.
   PubMed Web of Science ®Google Scholar
• Lee MJ, Kim M, Kim N-H, et al. Why is asymptomatic bacteriuria overtreated?: A tertiary care institutional survey of resident physicians. BMC Infect Dis. 2015;15(1):289.
   PubMedGoogle Scholar
• Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–1465.
   PubMed Web of Science ®Google Scholar
• Richards KA, Cesario S, Best SL, et al. Reflex urine culture testing in an ambulatory urology clinic: implications for antibiotic stewardship in urology. Int J Urol. 2019;26(1):69–74.
   PubMed Web of Science ®Google Scholar
• Jones CW, Culbreath KD, Mehrotra A, et al. Reflect urine culture cancellation in the emergency department. J Emerg Med. 2014;46(1):71–76.
   PubMed Web of Science ®Google Scholar
• Fok C, Fitzgerald MP, Turk T, et al. Reflex testing of male urine specimens misses few positive cultures may reduce unnecessary testing of normal specimens. Urology. 2010;75(1):74–76.
   PubMed Web of Science ®Google Scholar
• Humphries RM, Dien Bard J. Point-counterpoint: reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections. J Clin Microbiol. 2016;54(2):254–258.
   PubMed Web of Science ®Google Scholar
• Ourani M, Honda NS, MacDonald W, et al. Evaluation of evidence-based urinalysis reflex to culture criteria: impact on reducing antimicrobial usage. Int J Infect Dis. 2021;102:40–44.
   PubMed Web of Science ®Google Scholar
• Cho J, Oh KJ, Jeon BC, et al. Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment. Clin Chem Lab Med. 2019;57(11):1744–1753.
   PubMed Web of Science ®Google Scholar
• Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary tract infection and asymptomatic bacteriuria in older adults. Infect Dis Clin North Am. 2017;31(4):673–688.
   PubMed Web of Science ®Google Scholar
• Shaikh N, Morone NE, Lopez J, et al. Does this child have a urinary tract infection? JAMA. 2007;298(24):2895–2904.
   PubMed Web of Science ®Google Scholar
• Coughlin RF, Peaper D, Rothenberg C, et al. Electronic health record-assisted reflex urine culture testing improves emergency department diagnostic efficiency. Am J Med Qual. 2020;35(3):252–257.
   PubMed Web of Science ®Google Scholar
• Dougherty DF, Rickwa J, Guy D, et al. Reducing inappropriate urine cultures through a culture standardization program. Am J Infect Control. 2020;48(6):656–662.
   PubMed Web of Science ®Google Scholar
• Lynch CS, Appleby-Sigler A, Bork JT, et al. Effect of urine reflex culturing on rates of cultures and infections in acute and long-term care. Antimicrob Resist Infect Control. 2020;9(1):96. DOI:https://doi.org/10.1186/s13756-020-00762-1
   Google Scholar
• Dietz J, Lo TS, Hammer K, et al. Impact of eliminating reflex urine cultures on performed urine cultures and antibiotic use. Am J Infect Control. 2016;44(12):1750–1751.
   PubMed Web of Science ®Google Scholar
• Howard-Anderson JR, Ashraf S, Overton EC, et al. Sustained decrease in urine culture utilization after implementing a reflex urine culture intervention: a multicenter quasi-experimental study. Infect Control Hosp Epidemiol. 2020;41(3):369–371.
   PubMed Web of Science ®Google Scholar
• Leis JA. Advancing infection prevention and antimicrobial stewardship through improvement science. BMJ Qual Saf. 2018;27(2):163–165.
   PubMed Web of Science ®Google Scholar
• Eisinger SW, Schwartz M, Dam L, et al. Evaluation of the BD vacutainer plus urine C&S preservative tubes compared with nonpreservative urine samples stored at 4 °C and room temperature. Am J Clin Pathol. 2013;140(3):306–313.
   PubMed Web of Science ®Google Scholar
• LaRocco MT, Franek J, Leibach EK, et al. Effectiveness of preanalytic practices on contamination and diagnostic accuracy of urine cultures: a laboratory medicine best practices systematic review and meta-analysis. Clin Microbiol Rev. 2016;29(1):105–147.
   PubMed Web of Science ®Google Scholar
• Shaw KN, McGowan KL, Gorelick MH, et al. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics. 1998;101(6):e1–e1.
   PubMed Web of Science ®Google Scholar
• Dickerson JA, Fletcher AH, Procop G, et al. Transforming laboratory utilization review into laboratory stewardship: guidelines by the PLUGS national committee for laboratory stewardship. J Appl Lab Med. 2017;2(2):259–268.
   PubMedGoogle Scholar
• Munigala S, Rojek R, Wood H, et al. Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: analysis from a large academic medical center. Infect Control Hosp Epidemiol. 2019;40(3):281–286.
   PubMed Web of Science ®Google Scholar
• Siddiqui H, Nederbragt AJ, Lagesen K, et al. Assessing diversity of the female urine microbiota by high throughput sequencing of 16S rDNA amplicons. BMC Microbiol. 2011;11(1):244.
   PubMedGoogle Scholar
• Wolfe AJ, Toh E, Shibata N, et al. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012;50(4):1376–1383.
   PubMed Web of Science ®Google Scholar
• Hilt EE, McKinley K, Pearce MM, et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol. 2014;52(3):871–876.
   PubMed Web of Science ®Google Scholar
• van der Zee A, Roorda L, Bosman G, et al. Molecular diagnosis of urinary tract infections by semi-quantitative detection of uropathogens in a routine clinical hospital setting. PLoS One. 2016;11(3):e0150755.
   PubMed Web of Science ®Google Scholar
• Hinata N, Shirakawa T, Okada H, et al. Quantitative detection of Escherichia coli from urine of patients with bacteriuria by real-time PCR. Mol Diagn. 2004;8(3):179–184.
   PubMedGoogle Scholar
• Kaclíková E, Krascsenicsová K, Pangallo D, et al. Detection and quantification of Citrobacter freundii and C. braakii by 5'-nuclease polymerase chain reaction. Curr Microbiol. 2005;51(4):229–232.
   PubMed Web of Science ®Google Scholar
• Hansen WL, van der Donk CF, Bruggeman CA, et al. A real-time PCR-based semi-quantitative breakpoint to aid in molecular identification of urinary tract infections. PLoS One. 2013;8(4):e61439.
   PubMed Web of Science ®Google Scholar