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Best methods for urine sample collection for diagnostic accuracy in women with urinary tract infection symptoms: a systematic review.
Fam Pract. 2023 02 09; 40(1):176-182.FP

Abstract

BACKGROUND

Most guidelines recommend a midstream urine (MSU) or a midstream clean-catch (MSCC) sample for urinalysis. However, whether this sample is better than others is still controversial.

OBJECTIVES

To assess the most adequate non-invasive method to collect a urine specimen for diagnosing urinary tract infections (UTI) in symptomatic non-pregnant women.

METHODS

This review was conducted according to the Systematic Reviews of Diagnostic Test Accuracy guidelines (PROSPERO CRD42021241758). PubMed was searched paired sample studies and controlled trials. Studies comparing MSCC, MSU without cleaning, first-void urine, and random voiding samples were considered. Studies evaluating invasive methods were excluded. The main outcome was diagnostic accuracy of urine cultures. Contamination rates were evaluated. The risk of bias tool for systematic reviews on diagnostic accuracy (QUADAS-2) was assessed.

RESULTS

Six studies including 1,010 patients were evaluated. Only two studies used paired samples. No study was considered as having low risk of bias. There was no difference in contamination for MSU specimens collected with or without cleansing and between random void urine collection and MSCC. In one study comparing first-void urine with MSU samples, the contamination rate was lower in the latter, but the gold standard of urine culture was only used for one sampling collection.

CONCLUSIONS

To the best of our knowledge, this systematic review is the first to assess the evidence available from different exclusively non-invasive urine sampling. Despite being widely recommended, our review did not find consistent evidence that asking women to provide midstream samples with or without cleansing is better.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Llor C
Department of Public Health, General Practice, University of Southern Denmark, Odense, Denmark. University Institute in Primary Care Research Jordi Gol, CIBER de Enfermedades Infecciosas, Barcelona, Spain. Via Roma Health Centre, Catalan Institute of Health, Barcelona, Spain.
Moragas A
University Institute in Primary Care Research Jordi Gol, CIBER de Enfermedades Infecciosas, Barcelona, Spain. Universitat Rovira i Virgili. Jaume I Health Centre, Catalan Institute of Health, Tarragona, Spain.
Aguilar-Sánchez M
Microbiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
García-Sangenís A
University Institute in Primary Care Research Jordi Gol, CIBER de Enfermedades Infecciosas, Barcelona, Spain. Medicines Research Unit, Institut de Recerca en Atenció Primària Jordi Gol, Barcelona, Catalonia, Spain.
Monfà R
University Institute in Primary Care Research Jordi Gol, CIBER de Enfermedades Infecciosas, Barcelona, Spain. Medicines Research Unit, Institut de Recerca en Atenció Primària Jordi Gol, Barcelona, Catalonia, Spain.
Morros R
University Institute in Primary Care Research Jordi Gol, CIBER de Enfermedades Infecciosas, Barcelona, Spain. Medicines Research Unit, Institut de Recerca en Atenció Primària Jordi Gol, Barcelona, Catalonia, Spain. Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.

MeSH

HumansFemaleUrine Specimen CollectionSystematic Reviews as TopicUrinary Tract InfectionsUrinalysisSpecimen HandlingUrine

Pub Type(s)

Review
Journal Article

Language

eng

PubMed ID

35652481

Citation

Llor, Carl, et al. "Best Methods for Urine Sample Collection for Diagnostic Accuracy in Women With Urinary Tract Infection Symptoms: a Systematic Review." Family Practice, vol. 40, no. 1, 2023, pp. 176-182.
Llor C, Moragas A, Aguilar-Sánchez M, et al. Best methods for urine sample collection for diagnostic accuracy in women with urinary tract infection symptoms: a systematic review. Fam Pract. 2023;40(1):176-182.
Llor, C., Moragas, A., Aguilar-Sánchez, M., García-Sangenís, A., Monfà, R., & Morros, R. (2023). Best methods for urine sample collection for diagnostic accuracy in women with urinary tract infection symptoms: a systematic review. Family Practice, 40(1), 176-182. https://doi.org/10.1093/fampra/cmac058
Llor C, et al. Best Methods for Urine Sample Collection for Diagnostic Accuracy in Women With Urinary Tract Infection Symptoms: a Systematic Review. Fam Pract. 2023 02 9;40(1):176-182. PubMed PMID: 35652481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Best methods for urine sample collection for diagnostic accuracy in women with urinary tract infection symptoms: a systematic review. AU - Llor,Carl, AU - Moragas,Ana, AU - Aguilar-Sánchez,Mercedes, AU - García-Sangenís,Ana, AU - Monfà,Ramon, AU - Morros,Rosa, PY - 2022/6/3/pubmed PY - 2023/2/11/medline PY - 2022/6/2/entrez KW - female KW - systematic review KW - urinalysis KW - urinary tract infections KW - urine specimen collection SP - 176 EP - 182 JF - Family practice JO - Fam Pract VL - 40 IS - 1 N2 - BACKGROUND: Most guidelines recommend a midstream urine (MSU) or a midstream clean-catch (MSCC) sample for urinalysis. However, whether this sample is better than others is still controversial. OBJECTIVES: To assess the most adequate non-invasive method to collect a urine specimen for diagnosing urinary tract infections (UTI) in symptomatic non-pregnant women. METHODS: This review was conducted according to the Systematic Reviews of Diagnostic Test Accuracy guidelines (PROSPERO CRD42021241758). PubMed was searched paired sample studies and controlled trials. Studies comparing MSCC, MSU without cleaning, first-void urine, and random voiding samples were considered. Studies evaluating invasive methods were excluded. The main outcome was diagnostic accuracy of urine cultures. Contamination rates were evaluated. The risk of bias tool for systematic reviews on diagnostic accuracy (QUADAS-2) was assessed. RESULTS: Six studies including 1,010 patients were evaluated. Only two studies used paired samples. No study was considered as having low risk of bias. There was no difference in contamination for MSU specimens collected with or without cleansing and between random void urine collection and MSCC. In one study comparing first-void urine with MSU samples, the contamination rate was lower in the latter, but the gold standard of urine culture was only used for one sampling collection. CONCLUSIONS: To the best of our knowledge, this systematic review is the first to assess the evidence available from different exclusively non-invasive urine sampling. Despite being widely recommended, our review did not find consistent evidence that asking women to provide midstream samples with or without cleansing is better. SN - 1460-2229 UR - https://www.unboundmedicine.com/medline/citation/35652481/Best_methods_for_urine_sample_collection_for_diagnostic_accuracy_in_women_with_urinary_tract_infection_symptoms:_a_systematic_review_ DB - PRIME DP - Unbound Medicine ER -