Collection Of Urine Specimens Research Articles

The efficient workflow to decrease the manual microscopic examination of urine sediment using on-screen review of images

BackgroundThe manual microscopic examination (MME) of urine sediment is labor-intensive, time-consuming, and imprecise. Therefore, automated urinalysis systems based on flow cytometry or digital imaging techniques could replace MME. The purpose of this study was to evaluate the rate of MME using two automated urine sediment analyzers, alone and in combination. MethodsThis study was conducted using the freshly collected urine specimens of 1055 in-patients and 1119 out-patients. All samples were analyzed using UF-1000i (Sysmex Corporation) and Cobas 6500 instrument (Roche Diagnostics International). The rate of MME was evaluated using two analyzers, both individually and in combination. ResultsUsing the UF-1000i alone, 34.2% and 16.8%, respectively, of in- and out-patient samples were analyzed by MME, compared to 15.6% and 3.7%, respectively, using the Cobas 6500. In combined assay using the UF-1000i followed by the Cobas 6500, 27.9% and 11.3% in-patient samples required on-screen review and MME, respectively. And the respective rates were 10.3% and 2.7% of out-patient. Samples using the Cobas 6500 followed by the UF-1000i, 42.3% and 11.3% in-patient needed on-screen review and MME, respectively. And the respective rates were 18.9% and 2.7% of out-patient samples. ConclusionsUse of the Cobas 6500 compared to the UF-1000i resulted in decreases in the rate of MME from 34.2% to 15.6% for in-patient samples, and from 16.8% to 3.7% for out-patient samples. Use of the Cobas 6500 reduced the rate of MME, and compared to use of only the Cobas 6500, the combined use resulted in a reduction in the rate of on-screen review.

Chinese observational prospective study of ageing population with chronic kidney disease (C-OPTION): a study protocol

IntroductionThe proportion of elderly people is steadily rising worldwide, especially in low-income and middle-income countries, including China. Chronic kidney disease (CKD) is a common disorder in older people. However, little...

Drug use on in-patient wards

Phillips & Johnson reported on the very high prevalence of drug use among those with psychosis on psychiatric wards in two Boroughs in inner London ( Psychiatric Bulletin , June 2003, 27 , 217–220). During 2002, on one of the wards included in their study, we routinely collected urine specimens

Knowledge on Practice of Urinary Catheter Care and Compliance to Urinary Catheter Care Guidelines-A Hospital based Study

Background: Catheter associated urinary tract infections are the leading cause of secondary health care-associated bacteremia. An infection that involves any of the organs or structures of urinary tract infection including the kidneys, urethra, bladder and ureter is called as urinary tract infection. About 75% of urinary tract infections acquired in the hospital are because of the urinary catheters. Prolonged use of indwelling urinary catheter is one of the main risk of catheter associated urinary tract infection. Objective: To assess the knowledge on practice of urinary catheter care and compliance to urinary catheter care guidelines by the staff nurses. Materials and Method: Quantitative approach with descriptive survey design was used for the study. Staff nurses available during data collection and willing to participate were included. Purposive sampling technique was used to recruit the participants to assess the knowledge. By concealed observation practices of urinary catheter care were made to assess the compliance. Results:Majority 89(82.4%) of the participants had average knowledge, 18(16.7%) had good knowledge on prevention of catheter associated urinary tract infections. There was maximum noncompliance to the procedural steps while performing urine specimen collection, removal of urinary catheter and maintenance of urinary catheter. Conclusion:Nurses have to be aware of hospital policies and CDC guidelines in carrying out procedures like urinary catheter insertion, collection of urine specimens and maintenance of indwelling urinary catheter. Compliance of staff nurses is vital in reducing and preventing the occurrence of health care associated infection.

Urine Collection And Transport

The most common urine specimen received is the per-urethral voided urine. Healthy urethra is unsterile and it is extremely critical that urine specimens be collected carefully to minimise urethral contamination. There are several types of urine specimens and the results of each type are determined by different guidelines. Therefore, it is essential that each urine specimen received by the laboratory is clearly labelled as to the type of collection of urine specimen. JMS 2017; 20(1):52-53

Contaminated fingers: a potential cause of Chlamydia trachomatis-positive urine specimens

ObjectivesThe detection of an STI agent in a urogenital tract (UGT) specimen from a young child is regarded as being indicative of sexual abuse. However, the probabilities of contamination events...

Pasteurella aerogenes as an Asymptomatic Bacteriuria Agent

'Asymptomatic bacteriuria' (ASB) is isolation of a specified quantitative count of bacteria in an appropriately collected urine specimen obtained from a person without symptoms or signs referable to urinary infection. Catheterized specimens are less likely to be contaminated compared with voided specimens; therefore, positive cultures of catheterized specimens are more likely to reflect true bladder bacteriuria even with low colony counts. The common pathogens for ASB are Escherichia coli, Klebsiella and Streptococcus spp. Pasteurella spp. was not previously reported as an ASB agent. ASB is important for pregnant women, children, individuals with obstructive uropathy, chronic renal failure and neutropenia, before the urologic procedures and after renal transplantation. Treatment of ASB is required for above situations. We report an 11-year-old-girl with neurogenic bladder who made clean intermittent catheterization and had Pasteurella aerogenes as an ASB agent.

A pilot study on improving the appropriateness of urine specimen collection among catheterised patients in acute aged care

Abstract Background The culture of a urine specimen is one of the most common diagnostic investigations undertaken in the acute care environment. However, often urine specimen collection and culture is unnecessary, clinically inappropriate, leads to substantial over treatment and is a wasteful use of pathology. Furthermore urine specimen collection from patients with urinary catheters presents an opportunity for microorganisms to colonise the drainage system and cause clinical infection. Unnecessary specimen collection can also drive inappropriate antimicrobial use. A new decision support tool was developed to inform clinically appropriate urine specimen collection and culture for patients with urinary catheters. The aim of this study was to test the effect and practicality of this tool in an acute aged care setting. Methods Specimen collection, catheter utilisation and infection rates were collected for eight weeks pre- and post-implementation of the tool. Implementation of the tool was carried out for four weeks and included the provision of targeted nursing and medical education. Results The collection of catheter specimen urine (CSU) specimens and all urine specimens reduced after the implementation of the tool. Implementation of the new tool was also associated with a significant reduction in catheter days and catheter utilisation. Conclusion Implementation of the new decision support tool, together with the provision of targeted education, was associated with reducing the number of urine specimens collected and catheter dwell times in the unit.

Assessment of the validity of protein - osmolality ratio in a randomly collected urine specimen, in the estimation of proteinuria in children

Background Proteinuria is an important marker of kidney disease. Protein-creatinine ratio and protein-osmolality ratio in a spot urine sample have been proposed as alternatives to 24-hour urinary protein excretion, to simplify sample collection and minimize errors due to incorrect sample collection. Objective Study was to compare validity of urine protein-osmolality ratio and urine protein-creatinine ratio in a random urine sample against 24-hour urinary protein excretion, to detect proteinuria in a paediatric population. Methods A cross sectional descriptive study was conducted by recruiting 85 children with kidney disease from medical wards and nephrology clinic at Lady Ridgeway Hospital, as well as, 56 healthy children aged 3-12 years. Twenty four-hour urine samples and spot urine samples were collected from each participant. Urine protein-osmolality ratio and urine protein-creatinine ratio in the spot urine sample were determined and compared with 24-hour urinary protein excretion. Data was analysed using SPSS statistical package. Standard descriptive methods (mean, median, standard deviation etc.) were used to describe the measured parameters. Receiver Operator Characteristic (ROC) curves were created using protein-osmolality ratio and protein-creatinine ratio as test variables, and 24-hour urinary protein excretion as the ‘gold standard’ variable. Optimum cut of values, maximizing sensitivity and specificity, for protein-osmolality ratio and protein-creatinine ratio was determined using ROC curves. Results The optimal value discriminating normal from abnormal protein excretion was determined to be a protein-osmolality ratio of 0.38 mg/L: mOsm/kgH 2 O (sensitivity 85.7%, specificity 100%) and a protein-creatinine ratio of 28 mg/mmol (sensitivity 100%, specificity 94%). The cutoff value for discriminating mild from nephrotic proteinuria was to be a protein-osmolality ratio of 2.00 mg/L: mOsm/kgH 2 O (sensitivity 91.5%, specificity 100%) and a protein-creatinine ratio of 186 mg/mmol (sensitivity 93%, specificity 98.5%). Conclusions Both urine protein-creatinine ratio and urine protein-osmolality ratio can be used to determine nephrotic proteinuria. Urine protein-creatinine ratio was more sensitive than urine protein-osmolality ratio in detecting mild proteinuria from normal proteinuria.

The Effect of Written Posted Instructions on Collection of Clean-Catch Urine Specimens in the Emergency Department

BackgroundUrinalysis testing is frequently ordered in the emergency department (ED), but contamination of urine specimens limits the interpretation of results. The mid-stream, clean-catch (MSCC) procedure for urine specimen collection is recommended to decrease contamination rates, but without instructions this procedure has poor compliance. ObjectiveTo evaluate the effectiveness of written instructions alone, we analyzed the rate of specimen contamination, defined by presence of squamous epithelial cells (SECs) and culture results, in the ED after posting information on the MSCC procedure. MethodsInstructions in simple English for the MSCC procedure were posted in all patient-accessible restrooms in the ED. Frequency of contamination, defined microscopically as > 5 SECs per high-powered field or through growth of mixed or non-pathologic flora on urine culture, was determined over a 3-month period for comparison to historical controls from the previous year. ResultsDuring the intervention period, 754 urinalyses were sent, with 392 contaminated specimens (51.98%), and 193 urine cultures were sent, with 77 contaminated results (39.8%). Historical controls from the previous year yielded 827 urinalyses sent, with 430 contaminated (51.99%), and 251 urine cultures, with 125 contaminated results (49.8%). The difference between groups was not significant for urinalysis (p = 0.99) or urine culture (p = 0.13). ConclusionsA poster-based educational intervention with instructions on MSCC procedure failed to decrease contamination rates in this ED-based study. Possible explanations include poor compliance with MSCC technique in the ED, or poor efficacy of this technique at decreasing contamination rates. These results may indicate that other efforts are necessary to improve urine collection methods.

Gas chromatography/mass spectrometry-based urine metabolome study in children for inborn errors of metabolism: An Indian experience

ObjectiveThe present study highlights the feasibility of gas chromatography/mass spectrometry (GC/MS)-based analysis for simultaneous detection of >200 marker metabolites in urine found in characteristic pattern in inborn errors of metabolism (IEM) in India. Design and methodsDuring this retrospective study conducted from July 2013 to January 2016, we collected urine specimens on filter papers from Indian children across the country along with relevant demographic and clinical data. The laboratory technique involved urease pretreatment followed by deproteinization, derivatization, and subsequent computer-aided analysis of organic acids, amino acids, fatty acids, and sugars by GC/MS, which enable chemical diagnosis of IEM. ResultsTotally 23,140 patients were investigated for IEM with an estimated frequency of about 1.40%, that is, 323 positive cases. Most frequent disorders observed were of primary lactic acidemia (27.2%) and organic acidemia (methylmalonic aciduria, glutaric acidemia type I, propionic aciduria, etc.) followed by aminoacidopathies (maple syrup urine disease, phenylketonuria, tyrosinemia, etc.). Furthermore, alkaptonuria, canavan disease, and 4-hydroxybutyric aciduria were also diagnosed. Prompt treatment following diagnosis led to a better outcome in a considerable number of patients. ConclusionsGC/MS with one-step metabolomics enables quick detection, accurate identification, and precise quantification of a wide range of urinary markers that may not be discovered using existing newborn screening programs. The technique is effective as a second-tier test to other established screening technologies, as well as one-step primary screening tool for a wide spectrum of IEM.

Does perception of catheterization limit its use in pediatric UTI?

Urinary tract infections (UTIs) affect 3-8% of febrile children annually, but correctly diagnosing UTI in young children can present a challenge. Diagnosis requires a non-contaminated urine sample, which requires catheterization or suprapubic aspiration in infants and young children that have not completed toilet training. To improve adherence to these guidelines, it is critical to understand the barriers to urine testing and catheterization. The purpose of this study was to investigate parental perception of pediatric UTI evaluation to better understand factors that impede urine testing prior to treatment of suspected UTI. We conducted an electronic, cross-sectional survey via social media targeting parents of children with a history of UTI. Participants were queried regarding demographics, urine specimen collection method, factors influencing urine collection method, and perception of the experience. Multivariable logistic regression was used to assess factors associated with catheterization distress and urine testing. Of 2726 survey respondents, > 80% were female and White; 74% of the children with a history of UTI were female. Fifty-six percent of parents perceived extreme distress with catheterization. Among parents whose child was catheterized, extreme distress was less likely perceived if the parent was White (OR 0.6, 95% CI 0.4-0.9) or if the child was circumcised (OR 0.7, 95% CI 0.4-0.98). Among those whose child was not catheterized, extreme distress was more likely if parents had a college education (OR 3.2, 95% CI 2.2-4.5) and the child was more than 1 year old (OR 1.7, 95% CI 1.2-2.5). Catheterization was less likely to be withheld if parents had a college education (OR 0.1, 95% CI 0.1-0.2), and if the child was circumcised (OR 0.5, 95% CI 0.3-0.8) or had only one UTI (OR 0.6, 95% CI 0.4-0.8) (Table). Parental education level, child age, and circumcision status play an important role in the subjective distress associated with catheterization. This highlights the substantial impact of parental factors on adherence to guidelines for children suspected of UTI. For example, college-educated parents were more likely to be offered catheterization. However, these parents are also more likely to associate the catheterization experience with extreme distress, possibly limiting their likelihood of consent to this procedure. More studies are required to better understand the impact of these factors on catheterization. But, it is clear that parental input has a substantial impact on the evaluation of their child's suspected UTI.

Genotype-dependent metabolism of exogenous testosterone - new biomarkers result in prolonged detectability.

Testosterone (T) misuse still represents a major problem in sports drug testing. Many strategies have been developed and applied to routine doping controls in recent years to enable both to identify suspicious samples in initial testing procedures and to confirm the exogenous origin of urinary T by means of carbon isotope ratio (CIR) determinations. Depending on the tested individual's genotype of UGT2B17, significantly different amounts of T are glucuronidated and excreted, which results in unaffected T/epitestosterone ratios after T misuse in those subjects with the deletion/deletion polymorphism (del/del). The aim of this study was to investigate differences in metabolic pathways of orally administered T between persons of del/del and insertion/insertion (ins/ins) genetic polymorphism. Therefore, a recently established method using hydrogen isotope ratios together with high-resolution and high-accuracy mass spectrometry was applied after administration of deuterated T to n = 4 subjects including both genotypes. Participants collected urine specimens directly before and for up to 8 days after the application. Urine aliquots were prepared to yield unconjugated, glucuronidated, and sulphoconjugated fractions of urinary steroids. Besides the significant difference in the excretion of T-glucuronide, all measured metabolites varied rather on an individual basis than due to a genotype difference. New T metabolites (both methylated and de-methylated) were detected and investigated regarding their potential to enhance the screening for T misuse. Sulphoconjugated epiandrosterone was further identified as the biomarker allowing for a prolonged retrospective detection of T misuse by means of CIR determinations for up to 5 days compared to 1 day if currently applied sports drug testing procedures were used. Copyright © 2016 John Wiley & Sons, Ltd.

Androgen biosynthesis during minipuberty favors the backdoor pathway over the classic pathway: Insights into enzyme activities and steroid fluxes in healthy infants during the first year of life from the urinary steroid metabolome

The steroid profile changes dramatically from prenatal to postnatal life. Recently, a novel backdoor pathway for androgen biosynthesis has been discovered. However, its role remains elusive. Therefore, we investigated androgen production from birth to one year of life with a focus on minipuberty and on production of androgens through the backdoor pathway. Additionally, we assessed the development of the specific steroid enzyme activities in early life. To do so, we collected urine specimens from diapers in 43 healthy newborns (22 females) at 13 time points from birth to one year of age in an ambulatory setting, and performed in house GC–MS steroid profiling for 67 steroid metabolites. Data were analyzed for androgen production through the classic and backdoor pathway and calculations of diagnostic ratios for steroid enzyme activities were performed. Analysis revealed that during minipuberty androgen production is much higher in boys than in girls (e.g. androsterone (An)), originates largely from the testis (Anboys-Angirls), and uses predominantly the alternative backdoor pathway (An/Et; Δ5<Δ4 lyase activity). Modelling of steroid enzyme activities showed age-related effects for 21-, 11-, 17-hydroxylase and P450 oxidoreductase activities as well as 3β-hydroxysteroid dehydrogenase, 11β-hydroxylase type 1/2 and 5α-reductase activities. Sex-related characteristics were found for 21-hydroxylase and 5α-reductase activities. Overall, our study shows that androgen biosynthesis during minipuberty favors the backdoor pathway over the classic pathway. Calculations of specific diagnostic ratios for enzyme activities seem to allow the diagnosis of specific steroid disorders from the urinary steroid metabolome.

Determinants of practice patterns in pediatric UTI management

Urinary tract infection (UTI) affects 10% of girls and 3% of boys by age 16. Both the American Academy of Pediatrics and National Institute for Health and Clinical Excellence Guidelines recommend urine testing prior to initiation of antibiotic treatment and the use of local antibiograms to guide empiric antibiotic therapy. Urine culture results not only provide the opportunity to halt empiric therapy if there is no bacterial growth, but also allow for tailoring of broad-spectrum therapy. Additionally, the use of antiobiograms improves empiric antibiotic selection based on local resistance patterns. However, execution of guideline recommendations has proved challenging. Understanding barriers in implementation is critical to developing targeted interventions aimed to improve adherence to these guidelines. The present study sought to investigate practice patterns and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of UTI in children to ultimately improve adherence to UTI management guidelines. A random, national sample of physicians caring for children was surveyed from the American Medical Association Masterfile. Participants were queried regarding practice type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. Of respondents who acknowledged contact by surveyors, 47% completed the survey (n=366). Most respondents (84%) obtain urinalysis and culture prior to treatment for UTI. Physicians report they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%) (Table). Urine collection by bag was more common in circumcised boys (>30%) compared with girls (20%) and uncircumcised boys (20%) (P=0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization (Table). Of the 70% of respondents reporting antibiogram access (n=256), 50% report its use the majority of the time with empiric prescription (n=128). While most practitioners report following guidelines to obtain urine testing prior to antibiotic prescription for UTI, urine collection by bag is common. Additionally, <50% of practitioners adhere to guideline recommendations for empiric antibiotic selection based on local antibiograms. Interventions to improve adherence to UTI management guidelines should focus on (1) improving catheterization practices, (2) educating parents regarding the value of catheterization, and (3) incorporating local antibiograms into electronic medical records.

Preanalítica de orina de 24 horas: qué hacemos y qué deberíamos hacer

IntroductionGiven the need to standardise procedures for the collection, transportation, handling, and analysis of 24-hour urine specimens, international guidelines have been developed with a series of recommendations that should be adapted to each laboratory depending on its circumstances. ObjectiveTo determine the level of compliance to these recommendations in Spanish laboratories. Material and methodsA survey was carried out, through the website of the Spanish Society of Clinical Biochemistry and Molecular Pathology, on the different pre-analytical procedures in the management of 24hour urine specimens. ResultsA total of 50 laboratories responded, two of which were not Spanish. Although most laboratories provide information about the collection of the specimen, there is variability in how this is done. Differences were observed in areas such as, patient access to containers for collecting urine without preservative, how to deliver the specimen, recording the associated information, and rejection criteria of a specimen not collected correctly. ConclusionsThere is variability in compliance with international recommendations. A possible bias of the survey is that the participants were those who are more motivated by this issue, and therefore more faithful compliance with these standards, thus the variability detected could be even higher. Finally, the main recommendations for the standardisation of the entire procedure is reviewed in order to obtain a specimen quality to ensure good results.

Rapid, Non-Invasive Urine Collection is Feasible in Infants Up To 12 Months Old

Abstract BACKGROUND: In non-toilet trained children, collection of non-contaminated urine specimens for culture is done by urethral catheterization or suprapubic aspiration,both invasive procedures, or by clean-catch technique, which is time-consuming. A rapid, non-invasive method of urine collection from neonates has been recently described:a stimulated clean-catch technique, with an 87% success rate within 5 minutes (Herreros et al, Arch Dis Child 2013; 98:27-29). OBJECTIVES: To determine: 1) the success rate in obtaining urine specimens within 5 minutes from infants (birth-12 months) via this stimulated clean-catch method; and 2) the time to collection of a urine specimen, via the stimulated clean-catch method. DESIGN/METHODS: Subjects were consecutive infants requiring a urine specimen for urinalysis and/or urine culture, identified by nursing or medical staff in either the inpatient or outpatient areas of a regional hospital. Verbal consent was obtained from the parent or guardian. 10- 60 minutes after a feeding, the infant’s genitalia were cleaned, and a stimulated clean-catch urine collection was attempted. The method consists of holding the infant under the axillae, with legs dangling, and stimulating voiding by rapidly tapping the suprapubic area for 30 seconds, then gently massaging in a circular pattern over the paralumbar area bilaterally for 30 seconds. The tapping and massage are repeated alternately until the infant voids, and the urine is collected “mid-stream”. RESULTS: Urine collection was attempted 51times, from 43infants, and was successful within 5 minutes in 37of 51attempts (72%). In infants 0-30 days old, the success rate was 64% (14 of 22 attempts). In infants 31-90 days old, the success rate was 93% (14 of 15 attempts). In infants 3-6 months old, the success rate was 67% (4 of 6 attempts). In infants 6-12 months old, the success rate was 63% (5 of 8attempts). The time to successful urine collection was recorded in 26cases, with both a median and a mean time of 85seconds. In 77% of the successful collections, the urine was obtained within 2 minutes. CONCLUSION: The stimulated clean-catch method of urine collection is useful in infants up to 1 year of age. In most cases of successful urine collection, the infant will void within 2 minutes.

English

Asymptomatic bacteriuria, a form of urinary tract infections that involves isolation of a specified quantitative count of bacteria in an appropriately collected urine specimen obtained from a person without symptoms or signs referable to urinary infection is common, but the prevalence in population varies widely with age, sex and the presence of genitourinary abnormalities. This study therefore aimed at investigating the prevalence of asymptomatic bacteriuria among selected students of Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife Nigeria as well as the antibiotic resistance patterns of the bacterial isolates associated with the condition. Urine samples were collected from one hundred apparently healthy students and processed within two hours of collection. The isolates were identified by conventional biochemical tests while antibiotic susceptibility of the isolates were carried out according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Results revealed 77% prevalence (49 females, 27 males) among the sample studied with the presence of Staphylococcal spp., Klebsiella spp., Citrobacter spp. and Bacillus spp. Staphylococcus aureus is the predominant species accounting for 54.5% of the isolates. Antibiotic susceptibility study revealed all the isolates to be multidrug resistant. However, resistance to ofloxacin by Gram-negative bacterial isolates was least while resistance to streptomycin by the Gram-positive isolates was least in this study. The study concluded that multidrug resistant bacteria can be associated with asymptomatic bacteriuria while the patients may not develop any sign or symptom referable to urinary tract infection. Key words: Asymptomatic bacteriuria, urinary tract infections, genitourinary abnormalities, prevalence, multidrug resistance.

MP24-03 DIRECT DETECTION OF URINARY TRACT INFECTION FROM URINE SAMPLES USING MATRIX-ASSISTED LASER DESORPTION IONIZATION-TIME OF FLIGHT MASS SPECTROMETRY

INTRODUCTION AND OBJECTIVES: Traditionally, the microbiological confirmation of urinary tract infection (UTI) takes 2-3 days. Before the results are available, clinicians initiate treatment with antibiotics. These antibiotics are in many cases unnecessary, inefficient or cover a wider spectrum of microorganism than necessary and as results, the antibiotics resistance bacteria may be possible to produce. Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) becomes a rapid tool of the identification of bacteria and yeast. Thus, we collected urine specimens and compared between the results of conventional confirmation and these of directly identification by MALDI-TOF MS. METHODS: Urine samples were gathered from patients with UTI symptoms processed by conventional culture between January and September 2015 in Kobe University Hospital. These specimens grow in culture and analyzed the conventional confirmation and MALDI-TOF MS identification by Vitek MS system (bioM erieux). According to the manufacture, a score 2.0 indicated species identification, a score between 1.7 to 2.0 indicated genus identification and a score of < 1.7 indicates no identification. RESULTS: We tested these specimens [gram positive rods (GPR): 3.48 %, gram positive cocci (GPC): 33.7 %, gram negative rods (GNR): 59.3 % and Candida species: 3.52 %] isolated by conventional confirmation. The bacteria isolated directly by MALDI-TOF MS ( 2.0) were 66.7 % of GPR, 24.1% of GPC, 70.6% of GNR and no Candida species, and the bacteria ( 1.7) were 66.7 % of GPR, 44.8 % of GPC, 88.2 % of GNR and none of Candida species from urine samples. The most relevant bacteria was Escherichia coli (34.9 %), followed by Staphylococcus aureus (8.14 %) and Staphylococcus epidermidis (8.14 %). CONCLUSIONS: MALDI-TOF MS showed high rate of accuracy about 90% for the identification of GNR, but not GPR, GPC and Yeast. This strategy could become a rapid (15 minutes per sample) and accurate diagnostic method of especially in GNR-causing UTI so far and further improvement is necessary for application to GPR, GPC and Yeast by for instance revised condition setting. This may accomplish a strong possibility to improve the adequacy of UTI treatment in terms of reducing the time of empiric antibiotic treatment or allowing for the earlier withdrawal of unnecessary antibiotics.

Sole Dependence on Urine Testing Strips and the Ability to Identify Clinically Significant Disease: Challenging the Current Paradigm for Heme Detection in General Clinical Situations.

The ability of health care professionals to provide patient care is potentially compromised when predicated on untested, although longstanding, perspectives. One such example is urinalysis testing, which has been currently simplified to use only urine testing strips for detection of microscopic hematuria. To determine whether urine testing strips are sufficient for identification of clinically significant findings in urinalysis. To determine the presence of microscopic hematuria, I examined a collection of urine specimens that had tested heme negative during the 3-month study period. Of the 342 patients from whom urine specimens were examined during this interval, 50 had microscopic hematuria, despite having tested negative for heme via urine testing strip. Also, 30% were not receiving any medication known to produce microscopic hematuria, and 18% had clinically significant pathology. Diagnosis of significant clinical pathologic manifestations would have been compromised had microscopic examination not been performed on the urine specimens from the cohort individuals. Examination of the novel approach of including microscopic examination of specimens in a specific clinical situation challenges the dominant paradigm of reliance on assaying using urine testing strips only, revealing that the current method is not only unreliable for determining microscopic hematuria but also is less than optimal in general clinical practice. The findings of this study provide evidence of the importance of microscopic evaluation as a routine component of urinalysis.