Laboratory Test Reference Guide

Many tests are not clinically indicated. Symptoms of a Urinary Tract Infection include: Dysuria, frequency, urgency, loin pain, polyuria, suprapubic tenderness, flank or loin pain and fever (in the absence of an alternative source for fever. Symptoms of UTI do NOT include cloudy or smelly urine.

Half of urine samples have significant contamination so are unhelpful and put the patient at risk of unnecessary and inaccurate treatment.  Coach the patient in how to collect a clean MSU.

BPAC says: People with symptoms of uncomplicated UTI do not require a urine culture. 

• Urinalysis or culture should not be performed if there is no clinical evidence of urinary tract infection (UTI). Pregnant women and prior to urological surgery are the two exceptions to this rule.

Follow up testing

• Follow-up testing of positive urine cultures after treatment is not indicated in the absence of persistent clinical symptoms.

Only repeat a urine culture within 24 hours if the previous sample was contaminated and the patient and the patient has not started antibiotics.

A note on the elderly

• Dipstick urinalysis is not an appropriate pre-laboratory investigation for suspected UTI in older patients. In the elderly asymptomatic bacteriuria is common (up to 30%) and should not be treated.
• Do not Perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection.
• Alternative causes for behavioural change or delirium (e.g. dehydration, medication interactions) should be excluded prior to urine culture or empiric antibiotics in frail older patients without specific symptoms relating to the urinary tract.

People with catheters

• Do not request a CSU unless a catheterised patient has features of sepsis.
• Do not send urinary catheter tips for culture.
• Do not send urine from a catheter bag

Catheter colonisation is the norm; treatment is only indicated if a patient has features of sepsis. CSUs frequently show polymicrobial colonisation and seldom establish a diagnosis of UTI. 

• Do not request urine culture in undiagnosed kidney disease(new AKI or CKD and a raised creatinine, haematuria or proteinuria) without sepsis. urine examination for casts, cells and protein but do not require culture.
• Do not order routine screening urine analyses (UA) in healthy, asymptomatic pediatric patients as part of routine well child care.

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