Urine Bench Flashcards
Procedure for CCMS specimens
- calibrated loops?
- How is colony count determined?
Clean genitals, expel fists 1/3 of urine, collect middle 1/3 for culture, and expel the remaining 1/3
- use .001 ml cal loop
- 10, 000 CFU/ml (of 1 or 2 organisms)= identify and do susceptibilities (3 or more organisms is contamination)
- > 100,000 CoNS is treated like pathogen
Procedure for foley (indwelling) cath specimens
- calibrated loops?
- How is colony count determined?
Clamp cath for 1/2 to 1 hour, take the specimen from catcher tubing (not cath bag). Cath tips will not be culturedClean genitals, expel fists 1/3 of urine, collect middle 1/3 for culture, and expel the remaining 1/3
- use .001 ml cal loop
- 10, 000 CFU/ml (of 1 or 2 organisms)= identify and do susceptibilities (3 or more organisms is contamination)
- > 100,000 CoNS is treated like pathogen
define: in-and-out catheter
- calibrated loops?
- How is colony count determined?
Obtained by catheterizing the patient to obtain the sample
- use .001 ml cal loop
- 10, 000 CFU/ml (of 1 or 2 organisms)= identify and do susceptibilities (3 or more organisms is contamination)
- > 100,000 CoNS is treated like pathogen
Define: - cystoscopy
Obtained at time of cystoscopy, sometimes collected from meters at time of cystoscopy. These are labeled right or left kidney urine.
Define: suprapubic aspirate
- calibrated loops?
- How is colony count determined?
Collected directly from the bladder by using a syringe and needle entering the bladder through the skin
- divide BAP, MAC and CNA into two segments (“2” and “3”) using .001 ml loop streak “3” side, .01 ml loop break “2” side and Inoculate a thio tube.
- if growth, perform colony count and identify all organisms and perform susceptibilities
- if thio only is growing, Gram stain and set up appropriate media
Recommended media for CCMS
- purpose of medium
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs
Recommended media for Foley cath
- purpose of medium
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs
Recommended media for in-and-out
- purpose of medium
BAP - All purpose medium (hemolysis)
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs
Recommended media for suprapubic
- purpose of medium
BAP - All purpose medium (hemolysis)
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs
THIO - Enhances aerobes, facultative, and obligate anaerobes
Recommended media for cytoscopy
- purpose of medium
BAP - All purpose medium (hemolysis)
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs
THIO - Enhances aerobes, facultative, and obligate anaerobes
What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: CCMS
> or = to 10,000 CFU/mL
What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: foley cath
> or = to 10,000 CFU/mL
What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: in-and-out
> or = to 1,000 CFU/mL
What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: suprapubic
> or = to 1,000 CFU/mL
What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: cystoscopy
> or = to 1,000 CFU/mL
What most common Staph causes UTIs?
- what tests should you run?
- results?
Staph aureus
Staph saprophyticus
What most common Strep causes UTIs?
- what tests should you run?
- results?
Enterococci Streptococcus agalactiae (group B) Strep pyogenes (Group A)
What most common GNR causes UTIs?
- what tests should you run?
- results?
Enterobacteriaceae: E. coli Pseudomonas Proteus Klebiella
What most common GPR causes UTIs?
- what tests should you run?
- results?
Clostridium species
Bacillus species: (almost always considered contamination)
What most common Corynebacterium causes UTIs?
- what tests should you run?
- results?
ureliticum
What most common Yeast causes UTIs?
- what tests should you run?
- results?
Candida species
What most common Staph causes UTIs?
- what tests should you run?
- results?
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What most common Staph causes UTIs?
- what tests should you run?
- results?
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Correlate the number of organisms seen on a gram stained direct smear of urine with the overall colony count
presence of one or more organisms per OIF correlates with a colony count of > 10^5
Correlate the presence of many squamous epithelial cells in a direct smear with specimen quality
presence of many squamous epithelial cells indicates contamination
List 5 most common contaminants found in urine cultures due to improper collection technique
- CoNS
- Cornebacterium
- Lactobacillus
- Viridans Strep
- Bacillus species
Colony/gram stain morphologies of: CoNS
GPC
Colony/gram stain morphologies of: Corynebacterium
GPR
Colony/gram stain morphologies of: Lactobacillus
GPR - skinny
Colony/gram stain morphologies of: Viridans strep
GPC
Colony/gram stain morphologies of: Bacillus species
GPR - boxcar
List the criteria for establishing an unsatisfactory urine (contaminated specimen warranting a repeat specimen), based on culture results
if not in boric acid tube, or if in tube longer than 48 hours and if not in a sterile container and on ice
(? 3 or more organisms with > or = 10,000 CFU/mL (or>1,000 for group 2) ?)
What screening medium and rapid biochemical test may be used in smaller labs to identify Escherichia coli in urine cultures
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What is the proper method for transporting and holding urine specimens?
> 2 hours: transport in a urine transport with boric acid at room temp, otherwise refrigerate or keep on ice until culture can be done
What antibiotic is only tested on urine pathogens (and is only used in treatment of urinary tract infections
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What are the more common, non-culture, screening methods employed for detecting urinary tract infections
- overall general sensitivity/specificity of these methods
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clinical signs and symptoms of urinary tract infections involving the upper urinary tract
flank pain, nausea, vomiting, fevers, chills, night sweats, and costovertebral angle tenderness
clinical signs and symptoms of urinary tract infections involving the lower urinary tract
uncomplicated: dysuria, frequency, urgency, suprapubic pain, and hematuria
effects of various host facts on the predisposition for urinary tract infections
gender: mostly women
age: 65 and older, incidence increases dramatically
indwelling caths: bad care/ length of time/ patient susceptibility
pregnancy: enlarged uterus pressure & hormones
disease:
sexual activity: usually uncomplicated UTIs in sexually active young women
stones:
complications that can arise from an untreated or undiagnosed urinary tract infection
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