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Abnormal urinalysis results are common, regardless of specimen collection technique, in women without urinary tract infections.
J Emerg Med. 2015 Jun; 48(6):706-11.JE

Abstract

BACKGROUND

Voided urinalysis to test for urinary tract infection (UTI) is prone to false-positive results for a number of reasons. Specimens are often collected at triage from women with any abdominal complaint, creating a low UTI prevalence population. Improper collection technique by the patient may affect the result. At least four indices, if positive, can indicate UTI.

OBJECTIVE

We examine the impact of voided specimen collection technique on urinalysis indicators of UTI and on urine culture contamination in disease-free women.

METHODS

In this crossover design, 40 menstrual-age female emergency department staff without UTI symptoms collected urine two ways: directly in a cup ("non-clean") and midstream clean catch ("ideal"). Samples underwent standard automated urinalysis and culture. Urinalysis indices and culture contamination were compared.

RESULTS

The proportion of abnormal results from samples collected by "non-clean" vs. "ideal" technique, respectively, were: leukocyte esterase (>trace) 50%, 35% (95% confidence interval for difference -6% to 36%); nitrites (any) 2.5%, 2.5% (difference -2.5 to 2.5%); white blood cells (>5/high-powered field [HPF]) 50%, 27.5% (difference 4 to 41%); bacteria (any/HPF) 77.5%, 62.5%, (difference -7 to 37%); epithelial cells (>few) 65%, 30% (difference 13 to 56%); culture contamination (>1000 colony-forming units of commensal or >2 species) 77%, 63% (difference -5 to 35%). No urinalysis index was positively correlated with culture contamination.

CONCLUSION

Contemporary automated urinalysis indices were often abnormal in a disease-free population of women, even using ideal collection technique. In clinical practice, such false-positive results could lead to false-positive UTI diagnosis. Only urine nitrite showed a high specificity. Culture contamination was common regardless of collection technique and was not predicted by urinalysis results.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Frazee BW
Department of Emergency Medicine, Oakland, California.
Enriquez K
Department of Emergency Medicine, Oakland, California.
Ng V
Department of Pathology, Alameda Health System - Highland Hospital, Oakland, California.
Alter H
Department of Emergency Medicine, Oakland, California.

MeSH

AdultCarboxylic Ester HydrolasesColony Count, MicrobialCross-Over StudiesEpithelial CellsFalse Positive ReactionsFemaleHumansLeukocyte CountNitritesProspective StudiesUrinalysisUrinary Tract InfectionsUrine Specimen Collection

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

25841289

Clinical Trial Links

Urinalysis Results in Healthy Individuals

Citation

Frazee, Bradley W., et al. "Abnormal Urinalysis Results Are Common, Regardless of Specimen Collection Technique, in Women Without Urinary Tract Infections." The Journal of Emergency Medicine, vol. 48, no. 6, 2015, pp. 706-11.
Frazee BW, Enriquez K, Ng V, et al. Abnormal urinalysis results are common, regardless of specimen collection technique, in women without urinary tract infections. J Emerg Med. 2015;48(6):706-11.
Frazee, B. W., Enriquez, K., Ng, V., & Alter, H. (2015). Abnormal urinalysis results are common, regardless of specimen collection technique, in women without urinary tract infections. The Journal of Emergency Medicine, 48(6), 706-11. https://doi.org/10.1016/j.jemermed.2015.02.020
Frazee BW, et al. Abnormal Urinalysis Results Are Common, Regardless of Specimen Collection Technique, in Women Without Urinary Tract Infections. J Emerg Med. 2015;48(6):706-11. PubMed PMID: 25841289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abnormal urinalysis results are common, regardless of specimen collection technique, in women without urinary tract infections. AU - Frazee,Bradley W, AU - Enriquez,Kayla, AU - Ng,Valerie, AU - Alter,Harrison, Y1 - 2015/04/01/ PY - 2014/09/12/received PY - 2015/02/13/revised PY - 2015/02/21/accepted PY - 2015/4/6/entrez PY - 2015/4/7/pubmed PY - 2016/3/5/medline KW - urinalysis KW - urinary tract infection SP - 706 EP - 11 JF - The Journal of emergency medicine JO - J Emerg Med VL - 48 IS - 6 N2 - BACKGROUND: Voided urinalysis to test for urinary tract infection (UTI) is prone to false-positive results for a number of reasons. Specimens are often collected at triage from women with any abdominal complaint, creating a low UTI prevalence population. Improper collection technique by the patient may affect the result. At least four indices, if positive, can indicate UTI. OBJECTIVE: We examine the impact of voided specimen collection technique on urinalysis indicators of UTI and on urine culture contamination in disease-free women. METHODS: In this crossover design, 40 menstrual-age female emergency department staff without UTI symptoms collected urine two ways: directly in a cup ("non-clean") and midstream clean catch ("ideal"). Samples underwent standard automated urinalysis and culture. Urinalysis indices and culture contamination were compared. RESULTS: The proportion of abnormal results from samples collected by "non-clean" vs. "ideal" technique, respectively, were: leukocyte esterase (>trace) 50%, 35% (95% confidence interval for difference -6% to 36%); nitrites (any) 2.5%, 2.5% (difference -2.5 to 2.5%); white blood cells (>5/high-powered field [HPF]) 50%, 27.5% (difference 4 to 41%); bacteria (any/HPF) 77.5%, 62.5%, (difference -7 to 37%); epithelial cells (>few) 65%, 30% (difference 13 to 56%); culture contamination (>1000 colony-forming units of commensal or >2 species) 77%, 63% (difference -5 to 35%). No urinalysis index was positively correlated with culture contamination. CONCLUSION: Contemporary automated urinalysis indices were often abnormal in a disease-free population of women, even using ideal collection technique. In clinical practice, such false-positive results could lead to false-positive UTI diagnosis. Only urine nitrite showed a high specificity. Culture contamination was common regardless of collection technique and was not predicted by urinalysis results. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/25841289/Abnormal_urinalysis_results_are_common_regardless_of_specimen_collection_technique_in_women_without_urinary_tract_infections_ DB - PRIME DP - Unbound Medicine ER -
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