Re: FW: Outpatient Urine culture: Does collection Technique Matter:
From: art fougner, md (evsono@pipeline.com)
Mon Sep 25 12:36:00 2000
guess we'll be seeing a lot more cath specimens after this.
art
At Mon, 25 Sep 2000, Robert J Woolley wrote:
>
>---------- Forwarded message ----------
>Date: Mon, 25 Sep 2000 08:54:02 -0500
>From: "Woolley, Robert" <rwoolley@bhs.umn.edu>
>To: "'wooll005@tc.umn.edu'" <wooll005@tc.umn.edu>
>Subject: FW: Outpatient Urine culture: Does collection Technique Matter:
>
>-----Original Message-----
>From: Ehlinger, Ed Sent: Monday, September 25, 2000 8:43 AM
>To: Providers
>Subject: FW: Outpatient Urine culture: Does collection Technique Matter:
>
>I thought you'd be interested in this posting from the College Health
>Listserv.
>Ed
>
>Edward P. Ehlinger, MD, MSPH
>Director and Chief Health Officer
>Boynton Health Service
>University of Minnesota
>410 Church St. SE
>Minneapolis, MN 55455
>
>(612) 625-1612 office
>(612) 625-1434 fax
>
>-----Original Message-----
>From: Larry Neinstein [mailto:neinstei@USC.EDU]
>Sent: Sunday, September 24, 2000 11:56 AM
>To: SHS@listserv.utk.edu
>Subject: Outpatient Urine culture: Does collection Technique Matter:
>
>Outpatient Urine culture: Does collection Technique Matter:
>As I was ripping up journal articles this weekend for filing, I found that
>occasional gem of an article. Since many moons ago in medical school, I
>learned and have since taught that "clean catch mid stream urine
>collections" were important for diagnosing UTIs correctly. If we received a
>urine culture with result of "contaminated", it was "the clinician did not
>teach the patient correctly or the nurse did not or the lab did not etc or
>often "the patient just cannot follow directions". However, sometimes a
>clinician/nurse will ask the important question "is this true" and then go
>out and research it. This article goes on to say (excuse my language here),
>"shit happens".
>The abstract is posted below from the arch intern med web site.
>http://www.archinternmed.com
>Outpatient Urine culture: Does collection Technique Matter:
>Edward Lifshitz, Liane Kramer: Arch Intern Med: 160, sept, 11,2000
>Background Dysuria is one of the most common presenting complaints of young
>women, and urinalysis is one of the most common laboratory tests performed.
>Despite the fact that the midstream clean-catch technique is commonly used
>for urine collection, contaminated urine cultures occur with distressing
>regularity. The midstream clean-catch technique is time-consuming to
>explain, frequently not performed correctly by patients, costly for
>supplies, often embarrassing for patients and staff, and of unproven
>benefit. Therefore, we designed a study to compare various methods of
>obtaining specimens for culture from acutely dysuric young women.
>Methods A total of 242 consecutive female patients who presented with
>symptoms suggestive of a urinary tract infection were randomized into 3
>groups. The first group (n = 77) was instructed to urinate into a clean
>container. No cleansing was done, and the specimen was not obtained
>midstream. The second group (n = 84) was instructed to collect a midstream
>urine sample with perineal cleansing and spreading of the labia. In an
>attempt to decrease contamination from the vagina, the third group (n = 81)
>was given the same instructions as group 2, with the addition of using a
>vaginal tampon. Contamination rates were calculated for all 3 groups.
>Results Contamination rates for the 3 groups were nearly identical (29%,
>32%, and 31%, respectively). Comparing the no-cleansing group with the
>combined cleansing, midstream groups also showed no difference in
>contamination rates (28.6% and 31.5%, respectively, with P = .65).
>Conclusions In young, outpatient women with symptoms suggestive of a
>urinary tract infection, the midstream clean-catch technique does not
>decrease contamination rates.
>My Comments: In looking at their data, all three groups had almost
>identical rates of E. Coli, 48%, 49% and 51% also as well as almost
>identical rates of no growth, 14%, 18% and 12%. They also examined the
>growth rate just using the collection jar to assure that this was not
>causing any false readings using straight sterile saline and this yielded no
>growth. This study was conducted in young healthy females with UTI symptoms
>(our population).
>Their summary at the end states: "Overall, our results suggest that it may
>not be necessary for urine cultures to be collected by means of MSSC
>technique in young women with symptoms suggestive of cystitis. Abandoning
>the use of the MSSC technique in this population may be warranted, thereby
>resulting in considerable saving in money, time and embarrassment. We
>believe that further studies should be performed to see whether the same
>result would be obtained in male patients, patient with more complicated
>urologic histories, and patients with signs and symptoms suggestive of upper
>or complicated urinary tract infections."
>This has been a long standing difficult, time consuming, "blame" the other
>department/person procedure. It is time to the ask a few questions:
>Is this procedure really necessary?
>Is anyone to "blame" for a "contaminated specimen"?
>I would suggest that perhaps 3-4 larger college health centers join me in a
>collaborative study to repeat this and confirm these results and perhaps
>save staff time and patient embarrassment. Please email me if you are
>interested and we can discuss procedures and IRB approval.
>Thanks,
>Larry
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
