Abstract
Objective: Urine is the most frequent specimen received for culture/sensitivity by clinical laboratories. The microbiological performance of HiCrome UTI agar medium was compared with Blood agar and MacConkey agar for isolation and presumptive identification of bacteria from urine culture. Methods: A total of 443 consecutively collected midstream and/or catheter-catch urine samples from patients attending the Islami Bank Medical College Hospital, Rajshahi, Bangladesh during January to December, 2012 were cultured. Urine samples showing pus cells ≥ 5/HPF were inoculated on to Blood agar (BA), MacConkey agar (MAC) and HiCrome UTI agar (CA) media simultaneously and incubated overnight aerobically at 370C. Rate of isolation and presumptive identification of bacterial species were compared for different media. Results: Culture yielded a total of 199 bacterial isolates from 189 (42.67%) positive plates including 179 (40.40%) unimicrobial and 10 (2.26%) polymicrobial (mixed growth of pair of bacteria) growths. Both HiCrome UTI agar and Blood agar media supported 100% growths while 151 (75.88%) growths were observed on MacConkey agar. The rate of presumptive identification was found significantly higher on HiCrome UTI agar (97.49%) than MAC agar (67.34%) (P<0.001) as primary urine culture medium. Of 199 isolates, E. coli was found to be the leading uropathogen isolated from 118 (59.30%) samples with its presumptive identification rate of 95.76%, 93.22% and 5.93% on CA, MAC and BA respectively. All 10 (100%) polymicrobial growths were demonstrated distinctly on CA against only 01(10%) on each BA and MAC. Conclusion: HiCrome UTI agar was found to be more useful as primary urine culture medium in both higher rate of isolation and presumptive identification of uropathogens in comparison to conventional media. Its inherent characteristics in demonstrating polymicrobial growth and ease of rapid identification by distinct colony colour are unique.
Highlights
Urinary tract infections are important clinical entities that account for significant outpatients load and hospital admissions globally, making urine, the most frequent sample received for culture.[1]
Patterns of bacterial isolates from urine culture are shown in Table-I. 189 culture-positive samples yielded a total of 199 bacterial isolates including 179 single and 10 polymicrobial growths
E. coli was the leading bacteria isolated from 118 (59.30%) samples followed by Staph. saprophyticus 38 (19.09%), Enterococcus spp. 23 (11.56%), Klebseilla spp. 11 (5.53%), Pseudomonas spp. 04 (2.01%), Proteus spp. 03 (1.51%) and Enterobacter spp. 02 (1.00%)
Summary
Urinary tract infections are important clinical entities that account for significant outpatients load and hospital admissions globally, making urine, the most frequent sample received for culture.[1]. The media should ideally be able to support the growth of all urinary pathogens and inhibit possible contaminants. Differentiation of lactose fermenter and non-fermenter is possible on MAC and CLED agar, but further species identification necessitates subculture or different biochemical tests with consequent longer reporting time and cost. Their limited capacities in maximizing the growth of possible pathogens rendered them unsuitable as an ideal primary isolation medium.[3]
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