Urine Culture

Urine culture is the "gold standard" test for diagnosing UTIs. Many sources have emphasized the midstream clean-catch technique as necessary for preventing contamination, although the value of this practice is uncertain (Lifshitz and Kramer, 2000). Bladder aspiration and catheterization are invasive sampling techniques. Urine from a catheter bag should not be used for culture, because bacterial contamination is typical.

More than one bacterial isolate on culture suggests contamination. Controversy exists regarding the threshold colony counts that define bacteruria consistent with infection. Although more than 105 colony-forming units per milliliter (CFU/mL) is a well-known cutoff, lower values are meaningful in certain patients. In patients with typical UTI symptoms, counts as low as 102 CFU/mL signify infection if Escherichia coli or other enterobac-teriaceae are isolated. A cutoff of 103 CFU/mL is appropriate in men with symptoms (Graham and Galloway, 2001).

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