Urine Bench

Question 1

Procedure for CCMS specimens

• calibrated loops?
• How is colony count determined?

Answer 1

Clean genitals, expel fists 1/3 of urine, collect middle 1/3 for culture, and expel the remaining 1/3

• use .001 ml cal loop
• 10, 000 CFU/ml (of 1 or 2 organisms)= identify and do susceptibilities (3 or more organisms is contamination)
• > 100,000 CoNS is treated like pathogen

Question 2

Procedure for foley (indwelling) cath specimens

• calibrated loops?
• How is colony count determined?

Answer 2

Clamp cath for 1/2 to 1 hour, take the specimen from catcher tubing (not cath bag). Cath tips will not be culturedClean genitals, expel fists 1/3 of urine, collect middle 1/3 for culture, and expel the remaining 1/3

• use .001 ml cal loop
• 10, 000 CFU/ml (of 1 or 2 organisms)= identify and do susceptibilities (3 or more organisms is contamination)
• > 100,000 CoNS is treated like pathogen

Question 3

define: in-and-out catheter
- calibrated loops?
- How is colony count determined?

Answer 3

Obtained by catheterizing the patient to obtain the sample

• use .001 ml cal loop
• 10, 000 CFU/ml (of 1 or 2 organisms)= identify and do susceptibilities (3 or more organisms is contamination)
• > 100,000 CoNS is treated like pathogen

Question 4

Define: - cystoscopy

Answer 4

Obtained at time of cystoscopy, sometimes collected from meters at time of cystoscopy. These are labeled right or left kidney urine.

Question 5

Define: suprapubic aspirate

• calibrated loops?

- How is colony count determined?

Answer 5

Collected directly from the bladder by using a syringe and needle entering the bladder through the skin

• divide BAP, MAC and CNA into two segments (“2” and “3”) using .001 ml loop streak “3” side, .01 ml loop break “2” side and Inoculate a thio tube.
• if growth, perform colony count and identify all organisms and perform susceptibilities
• if thio only is growing, Gram stain and set up appropriate media

Question 6

Recommended media for CCMS

- purpose of medium

Answer 6

MAC - selective for GNRs (lactose)

CNA - Selective for GPC/GPRs

Question 7

Recommended media for Foley cath

- purpose of medium

Answer 7

MAC - selective for GNRs (lactose)

CNA - Selective for GPC/GPRs

Question 8

Recommended media for in-and-out

- purpose of medium

Answer 8

BAP - All purpose medium (hemolysis)
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs

Question 9

Recommended media for suprapubic

- purpose of medium

Answer 9

BAP - All purpose medium (hemolysis)
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs
THIO - Enhances aerobes, facultative, and obligate anaerobes

Question 10

Recommended media for cytoscopy

- purpose of medium

Answer 10

BAP - All purpose medium (hemolysis)
MAC - selective for GNRs (lactose)
CNA - Selective for GPC/GPRs
THIO - Enhances aerobes, facultative, and obligate anaerobes

Question 11

What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: CCMS

Answer 11

> or = to 10,000 CFU/mL

Question 12

What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: foley cath

Answer 12

> or = to 10,000 CFU/mL

Question 13

What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: in-and-out

Answer 13

> or = to 1,000 CFU/mL

Question 14

What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: suprapubic

Answer 14

> or = to 1,000 CFU/mL

Question 15

What colony count is suggestive of infection and requires complete identification/susceptibility of the organism: cystoscopy

Answer 15

> or = to 1,000 CFU/mL

Question 16

What most common Staph causes UTIs?

• what tests should you run?
• results?

Answer 16

Staph aureus

Staph saprophyticus

Question 17

What most common Strep causes UTIs?

• what tests should you run?
• results?

Answer 17

Enterococci 
Streptococcus agalactiae (group B) 
Strep pyogenes (Group A)

Question 18

What most common GNR causes UTIs?

• what tests should you run?
• results?

Answer 18

Enterobacteriaceae: 
E. coli 
Pseudomonas
Proteus 
Klebiella

Question 19

What most common GPR causes UTIs?

• what tests should you run?
• results?

Answer 19

Clostridium species

Bacillus species: (almost always considered contamination)

Question 20

What most common Corynebacterium causes UTIs?

• what tests should you run?
• results?

Answer 20

ureliticum

Question 21

What most common Yeast causes UTIs?

• what tests should you run?
• results?

Answer 21

Candida species

Question 22

What most common Staph causes UTIs?

• what tests should you run?
• results?

Answer 22

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Question 23

What most common Staph causes UTIs?

• what tests should you run?
• results?

Answer 23

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Question 24

Correlate the number of organisms seen on a gram stained direct smear of urine with the overall colony count

Answer 24

presence of one or more organisms per OIF correlates with a colony count of > 10^5

Question 25

Correlate the presence of many squamous epithelial cells in a direct smear with specimen quality

Answer 25

presence of many squamous epithelial cells indicates contamination

Question 26

List 5 most common contaminants found in urine cultures due to improper collection technique

Answer 26

1. CoNS 2. Cornebacterium 3. Lactobacillus 4. Viridans Strep 5. Bacillus species

Question 27

Colony/gram stain morphologies of: CoNS

Answer 27

GPC

Question 28

Colony/gram stain morphologies of: Corynebacterium

Answer 28

GPR

Question 29

Colony/gram stain morphologies of: Lactobacillus

Answer 29

GPR - skinny

Question 30

Colony/gram stain morphologies of: Viridans strep

Answer 30

GPC

Question 31

Colony/gram stain morphologies of: Bacillus species

Answer 31

GPR - boxcar

Question 32

List the criteria for establishing an unsatisfactory urine (contaminated specimen warranting a repeat specimen), based on culture results

Answer 32

if not in boric acid tube, or if in tube longer than 48 hours and if not in a sterile container and on ice (? 3 or more organisms with > or = 10,000 CFU/mL (or>1,000 for group 2) ?)

Question 33

What screening medium and rapid biochemical test may be used in smaller labs to identify Escherichia coli in urine cultures

Answer 33

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Question 34

What is the proper method for transporting and holding urine specimens?

Answer 34

>2 hours: transport in a urine transport with boric acid at room temp, otherwise refrigerate or keep on ice until culture can be done

Question 35

What antibiotic is only tested on urine pathogens (and is only used in treatment of urinary tract infections

Answer 35

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Question 36

What are the more common, non-culture, screening methods employed for detecting urinary tract infections - overall general sensitivity/specificity of these methods

Answer 36

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Question 37

clinical signs and symptoms of urinary tract infections involving the upper urinary tract

Answer 37

flank pain, nausea, vomiting, fevers, chills, night sweats, and costovertebral angle tenderness

Question 38

clinical signs and symptoms of urinary tract infections involving the lower urinary tract

Answer 38

uncomplicated: dysuria, frequency, urgency, suprapubic pain, and hematuria

Question 39

effects of various host facts on the predisposition for urinary tract infections

Answer 39

gender: mostly women age: 65 and older, incidence increases dramatically indwelling caths: bad care/ length of time/ patient susceptibility pregnancy: enlarged uterus pressure & hormones disease: sexual activity: usually uncomplicated UTIs in sexually active young women stones:

Question 40

complications that can arise from an untreated or undiagnosed urinary tract infection

Answer 40

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