Urine Culture, Comprehensive

CPT: 87086
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Test Details

Synonyms

  • Culture, Urine, Comprehensive

Test Includes

Culture; quantitation, isolation, identification (additional charges/CPT code[s] may apply), and susceptibility testing of up to three organisms at >100 colonies/mL if culture results warrant (additional charges/CPT code[s] may apply). CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. Requests with only a written order and no test number indicated will be processed according to Default Testing for Routine Microbiology.

Use

Isolate and identify bacteria present in low numbers in the urinary tract; isolate and identify bacteria from females presenting with “urethral syndrome” for whom Urine Culture, Routine was not diagnostic.

Methodology

Culture

Additional Information

A single culture is about 80% accurate in the female; two containing the same organism with count of 105 or more represent a 95% chance of true bacteriuria; three such specimens mean virtual certainty of true bacteriuria. Urinary tract infection is significantly higher in women who use diaphragm-spermicide contraception, perhaps secondary to increased vaginal pH and a higher frequency of vaginal colonization with E coli.1 A single clean voided specimen from an adult male may be considered diagnostic with proper preparation and care in specimen collection. If the patient is receiving antimicrobial therapy at the time the specimen is collected, any level of bacteriuria may be significant. When more than two organisms are recovered, the likelihood of contamination is high; thus, the significance of definitive identification of the organisms and susceptibility testing in this situation is severely limited. A repeat culture with proper specimen collection including patient preparation is often indicated. Periodic evaluation of diabetics and pregnant women for asymptomatic bacteriuria has been recommended.2 Institutionalized patients, especially elderly individuals, are prone to urinary tract infections, which can be severe.3 Cultures of specimens from Foley catheters yielding multiple organisms with high colony counts usually represents colonization of the catheter and not true significant bacteriuria. Most laboratories limit the number of organisms that will be identified when recovered from urine to two. Similarly, most do not routinely perform susceptibility tests on isolates from presumably contaminated specimens. Failure to recover aerobic organisms from patients with pyuria or positive Gram stains of urinary sediment may indicate the presence of mycobacteria or anaerobes. As the number of patients who are chronically catheterized increases, so does the controversy on what constitutes a diagnostic specimen. Few clinical studies have been performed to support the identification of more then two organisms or implicate usual site flora (eg, diphtheroids, α- or γ-streptococci, and coagulase-negative staphylococci other than S saprophyticus).

Specimen Requirements

Specimen

Urine

Volume

To fill line on Vacutainer® gray-top urine culture transport tube

Container

Vacutainer® gray-top urine culture transport tube with preservative

Patient Preparation

Clean catch specimen: It may be easier for patients to urinate into a small clean disposable cup (styrofoam or “Dixie”). Afterward, collection site staff can transfer the urine to the urine culture container using the special collection straw-puncture device designed for use with the Vacutainer® tubes. The numbers of bacteria in a clean unused cup are so few as to be inconsequential when the urine transport stabilizer is added. Thoroughly instruct patient for proper collection of “clean catch” specimen. Patient must be instructed to thoroughly cleanse skin and collect a midstream specimen. The patient should be instructed to follow the directions provided with the urine collection kit as follows. Catheterized specimen: Refers to an “in and out” catheter that is placed into the bladder soley for collection of the specimen and then withdrawn. Do not collect urine from the drainage bag when an indwelling catheter is in place because growth of bacteria can occur in the bag itself. Rather, clean catheter with an alcohol sponge, puncture with a sterile needle, and collect in sterile syringe. Catheter tips are contaminated by the urethra as they are withdrawn; do not culture them. Male: Wash hands thoroughly with soap and water. Rinse them well and dry with a paper towel. • Tear open the towelette packages so that the towels can be easily removed with one hand as they are needed. Do not touch any of the inside surfaces of the collection cup.• Pull back the foreskin to expose the head of the penis completely.• Wash the head of the penis thoroughly using first one towelette then the other. Discard the used towelettes into the toilet bowl.• Pass a small amount of urine into the toilet bowl, then pass a sample into the container. Do not allow the container to touch the legs or the penis. Keep fingers away from the rim and inner surface of the container. Fill the container half full. • The urine specimen should be transferred to the Vacutainer® tube within 10 minutes of collection.Female: Wash hands thoroughly with soap and water. Rinse them well and dry with a paper towel. • Tear open the towelette packages so that the towels can be easily removed with one hand as they are needed. Do not touch any of the inside surfaces of the collection cup.• Remove undergarments and sit on the toilet seat with legs spread widely apart. • With one hand, spread labia apart to expose the vulva. Keep this hand in place during the washing and urinating procedure.• Use one towelette to wash the vulva well passing the towelette only from front to back, not back and forth. Repeat this procedure using the second towelette. Discard the used towelettes into the toilet bowl.• Begin urinating into the toilet bowl then, without stopping the stream, insert the collection cup to collect the specimen. Do not allow the container to touch the legs, vulva, or clothing. Keep fingers away from the rim and inner surface of the container. Fill the container about half full. • The urine specimen should be transferred to the Vacutainer® tube within 10 minutes of collection.

Collection

First morning specimens yield highest bacterial counts from overnight incubation in the bladder, and are the best specimens. Colony count interpretation standards are based on controlled studies from first early morning collections. Forced fluids or random specimens dilute the urine and may cause reduced colony counts. Hair from perineum will contaminate the specimen. The stream from a male may be contaminated by bacteria from beneath the prepuce. Bacteria from vaginal secretions, vulva, or distal urethra may contaminate transport. Organisms from hands or clothing might contaminate. Read Patient Preparation.

Storage Instructions

Maintain specimen at room temperature.

Causes for Rejection

Unrefrigerated unpreserved specimen older than two hours may be subject to overgrowth and may not yield valid results; unlabeled specimen or name discrepancy between specimen and request label; specimen in expired transport container; specimen received after prolonged delay (usually more than 36 hours for urine); specimen collected via a Foley catheter

Clinical Information

Special Instructions

Specimens from other sources, such as genital, stool, urine, upper and lower respiratory specimens, cannot be cultured under the aerobic bacterial culture test number. If specimens are incorrectly submitted with an order for aerobic bacterial culture, the laboratory will process the specimen for the test based on the source listed on the request form. The client will not be telephoned to approve this change, but the change will be indicated on the report.

Footnotes

1. Stamm WE, Hooton TM, Johnson JR, et al. Urinary tract infections: From pathogenesis to treatment. J Infect Dis. 1989 Mar; 159(3):400-406 (review). 2644378
2. Andriole VT. Urinary tract infections in the 90s: Pathogenesis and management. Infection. 1992; 20(Suppl 4):S251-S256. 1294512
3. Nicolle LE. Urinary tract infection in the elderly: How to treat and when? Infection. 1992; 20(Suppl 4):S261-S265. 1294514

References

Clarridge JE, Pezzlo MT, Vosti KL. Laboratory Diagnosis of Urinary Tract Infections. In: Weissfeld AS, ed. Cumitech 2. Washington, DC: ASM Press; March 1987.
Ronald AR, Nicolle LE, Harding GKM. Standards of therapy for urinary tract infections in adults. Infection. 1992; 20(Suppl 3):S164-S170. 1490743
Stamm WE. Criteria for the diagnosis of urinary tract infection and for the assessment of therapeutic effectiveness. Infection. 1992; 20(Suppl 3):S151-S159. 1490740

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
008086 Urine Culture,Comprehensive 630-4 008086 Urine Culture,Comprehensive 630-4
Reflex Table for Urine Culture,Comprehensive
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 997600 Result 997191 Result 1 630-4
Reflex Table for Urine Culture,Comprehensive
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 997600 Result 997192 Result 2 630-4
Reflex Table for Urine Culture,Comprehensive
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 997600 Result 997193 Result 3 630-4
Reflex Table for Urine Culture,Comprehensive
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 997600 Result 997194 Result 4 630-4
Reflex Table for Urine Culture,Comprehensive
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 997600 Result 997195 Antimicrobial Susceptibility 23658-8

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