Editing Urinary Tract Infections (section)

===== Laboratory =====
* '''<span style="color:#ff0000">Urinalysis'''
** '''<span style="color:#ff0000">The presumptive laboratory diagnosis of acute cystitis is based on microscopic urinalysis, which indicates microscopic pyuria, bacteriuria, and occasionally hematuria.'''
* '''<span style="color:#ff0000">Urine culture'''
** '''<span style="color:#ff0000">Remains the definitive test'''
***'''Clinical judgment is needed to determine when a culture result represents clinically significant bacteriuria considering the patient presentation, urine collection method, and the presence of other suggestive factors such as pyuria.'''
****'''<span style="color:#ff0000">The definition for clinically significant bacteriuria of >10<sup>5</sup> colony forming units (CFU)/mL represents an arbitrary cut-off.</span>'''
****'''Although > 10<sup>5</sup> CFU/mL for bacterial growth on midstream voided urine may help distinguish bladder bacteriuria from contamination in asymptomatic, pre-menopausal women, <span style="color:#ff0000">a lower 10<sup>2</sup> CFU/mL threshold may be appropriate in symptomatic individuals</span>'''
**'''Obtain repeat urine studies when an initial urine specimen is suspect for contamination, with consideration for obtaining a catheterized specimen'''
***'''Urine culture contamination should be suspected when (3):'''
***#'''Mixed cultures containing ≥2 organisms'''
***#'''Low quantities (<103 CFU/mL) of a pathogenic organism in an asymptomatic patient'''
***#'''Specimen exhibits growth of normal vaginal flora (e.g. Lactobacilli, Group B Streptococci, Corynebacteria, or non-saprophyticus coagulase-negative Staphylococci)'''
***#*'''Growth of these organisms are thought to be contaminant and generally do not require treatment'''
***'''Concomitant urinalysis can also be useful (presence of epithelial cells or mucus on microscopic urinalysis may also suggest contaminant).'''
***'''When there is high suspicion for contamination, consider obtaining a catheterized specimen for further evaluation prior to treatment.'''
***'''Urine specimens should not sit at room temperature for > 30 minutes to facilitate lab diagnosis of UTI.'''