COLLECTING URINE SPECIMENS FOR CULTURING

1. Urine continues to be most important specimen sent for culturing, we teach the under graduate
students majority of the specimens we receive are urine, and most common isolate is E.coli and
women suffer the UTI in greater proportions than men. With following of our statistics we find men
and women > 60 years of age are becoming greater victims of Urinary tract infections, and with
greater difficulties in interpretation with poor clinical information from the Doctors. My
observations many nurses consider urine is something carries lesser importance than blood for
culturing in septicaemia cases. Most laboratories and Unit chief’s leave the collection of urine for
cultures to ill experienced and very junior staff as Urine is least important specimens in the minds of
majority of the health care workers. Never forget today the people live longer with multiple
complication and constantly put on Medication. I wish if the Microbiologists take some interest in
explaining the importance of Urine collection to the senior staff in educating the patients on
collection.
The first question in urine collection is when we collect the urine
1 A Random sample, many out patients opt for giving a random sample that is anytime sample, this
is the specimen most commonly sent to the laboratory for analysis, primarily because it is the easiest
to obtain and is readily available. Random specimens can sometimes give an inaccurate results view
of a patient's health if the specimen is too diluted and analyse values are artificially lowered. As the
name implies, the random specimen can be collected at any time. Although there are no specific
guidelines for how the collection should be conducted, avoiding the introduction of contaminants
into the specimen is recommended. It is not possible to apply any standard criteria in bacterial
counts, and significant bacteria rarely applies to these patient when the specimens are collected
without much care, we just start to process major pathogens, as neither the clinician nor
microbiologist worried about the results. When we are student’s lot of importance was given to few
investigation we were doing and meticulous attention was paid in collecting and culturing of the
urine specimen, today many practitioners write the urine in routine fashion in particular many
pregnant women.
2 Early morning sample for culturing – if one is serious to establish and diagnose a UTI should switch
to early morning samples. This is the specimen of choice for culturing and microscopic analysis, since
the more quantity of urine is passed reducing the effects of processing of concentrated urine. Also
called an 8-hour specimen, the first morning specimen is collected when the patient first wakes up in
the morning, having emptied the bladder before going to sleep. Midstream Clean Catch Specimen
this is the preferred type of specimen for culturing and sensitivity testing because of the reduced
incidence of cellular and microbial contamination. Patients are required to first cleanse the urethral
area with an ordinary soap, can dry the area with towelette just simple tissue paper. The patient
should then void the first portion (fore stream) of the urine stream into the toilet. These first steps
significantly reduce the opportunities for contaminants to enter into the urine stream. The urine
midstream is then collected into a clean container tell the patient not more than half of the
container is needed or else it will spill and contaminate the surrounding with urine smell (any excess
urine should be voided into the toilet). This method of collection can be conducted at any time of
day or night.
3 Catheter Collection of urine Specimen - This assisted procedure is conducted when a patient is
bedridden or cannot urinate independently. The healthcare provider inserts a foley catheter into the

2. bladder through the urethra to collect the urine specimen. Specimens may also be collected through
an existing foley catheter with aseptic precautions.) Specimens may be collected directly from a
foley into an evacuated tube or transferred from a syringe into a tube or containers.
4 Paediatric Specimen For infants and small children, a special urine collection bag is adhered to the
skin surrounding the urethral area. Once the collection is completed, the urine is poured into a
collection container. Urine collected from a diaper is not recommended for laboratory testing since
contamination from the diaper material may affect test results. If you are getting isolates of
Pseudomonas please try your wisdom not to report as pathogen it will be misinterpreted by the
Paediatricians, and little children are subjected to toxic antibiotics Please explain the Broomhall
method as one of the ideal method ( Refer – 13th
Edition of Mackie on Diagnostic Microbiology
approaches)
If you wish to improve the quality of the services from diagnostic Microbiology on reporting of urine
for bacteriological evaluation a minimal clinical history is highly sought after which include,
1 Whether the urine is collected before or after the Antibiotic use, so even the lesser counts are
significant for consideration, when we put on broad spectrum antibiotics or Cephalosporins as the
counts will be reduced in established and persistent infection under the bacteriostatic effect of the
even narrow spectrum antibiotics ,
2 Should write whether the urine is collected from catheter and also should indicate in
postoperative cases, with probable days the catheter is put on without change, as most often we
get Candida or Pseudomonas as Major isolates which will disappear after the Catheter is removed,
3 What are the Antibiotics is patient is on
4 and ask them never forget to write when was the last culturing of urine was done what was the
report and what are the antibiotics prescribed, so we can have understanding on mistreated chronic
Urinary tract Infection
Note – With rapid Privatization of Diagnostic laboratories many ill experienced Microbiologists and
Technicians, many times insignificant growth of bacteria and commensals are processed and Anti
biograms are reported which continues to the major reason of the misuse of Antibiotics in major
outpatient settings.
Dr.T.V.Rao MD Professor of Microbiology Freelance writer,