Editing AUA & CUA Recurrent UTI (2019) (section)

==== Labs ====
*'''<span style="color:#ff0000">Urine culture/laboratory confirmation of significant bacteriuria</span>''' 
** '''Urine culture remains the mainstay of diagnosis of an episode of acute cystitis'''
*** '''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.