I was wondering what protocols others are using for urine culture screening.  Currently we have two ways to order a UA:  Urinalysis, and Urinalysis w Screen for Culture.  (We also have a straight urine C&S order -- we just do those without scrteening.

If the latter is ordered, we look at the following from a UA:  Esterase, Nitrite, and on microscopic: WBCs, and Yeast and/or bacteria.   If any of these four things is positive or present, we do a C&S.  If they are all negative, we cancel the C&S as "void per protocol".

Almost all of our UA orders now are Urinalysis w Screen for Culture.  The presence of bacteria (or something that looks like bacteria) causes the C&S to be done,  We get a lot of negative urine C&S s with this system.

Thanks,Scott

In our system the physician can either order a screen only, culture only, or a screen + culture. The lab does not reflex culture based off of the results when only a screen is ordered, so it is up to the physician to request an addon for a culture after viewing the results. If a culture is ordered it is worked up regardless of negative results for the UA. Cultures are probably ordered preemptively and thus worked up on > 70% of urines, but it really depends on the physician.  I would be curious as to what our stats are for urine culture growth rates. 

On a side note, how often do your hospitals perform urine microscopics? Ours are not order-able by physicians, but reflex off of any positive for PRO, NIT, WBC, BLOOD. As a result we read dozens a shift.

On regular UAs here (NOT being used for C&S screening), we do micros about 1/3 of the time. 

The problem is with our UA/culture screens.  We have to do a micro on each one to assess WBC and bacteria/yeast.  So besides doing a lot of extra cultures, we do a lot of extra micros as well.  This is our main problem (in my opinion) -- our screening protocol is too conservative.

Next year we will be getting a Urisys or equivalent.  Our protocols are going to have too change.

Scott

Our facility  offers 4 different UA tests - A UA (micro if indicated), UAT (microscopic done regardless of dipstick results), and then UACSI and UATCSI - that offer a culture if indicated.

Our microscopic review rate (we have an IRIS iQ system) and our mircoscopic rate is about 66%.  We reflex the microscopic for any of the following from the dipstick: non-clear urines, > 0.03 hgb,  > trace protein, positive leukocytes esterase and positive nitrites.

For urine culture we only reflex if we see 10 WBC/hpf on the microscopic - Leukocytes esterase and positive nitrites will trigger a microscopic exam, but only the presence of 10 or more WBCs/hpf triggers a culture. That has resulted in a huge decrease in negative cultures. 

Hope this helps - Evan

We offer UA dip only, UA reflex microscopy, UA reflex microscopy and culture.  The culture is only reflexed from the microscopy:  only needs to meet one criteria for reflex: > 10 WBC's, Bacteria present or Yeast Present.  We are using the AUWIPro.

On our "UA w/culture if" orders, we reflex to culture if:

Dip is Esterase +, and/or Nitrate+

Slide  is >5 wbc and/or >1+ bacteria

If specimen is a cath specimen, any bacteria will trigger a culture.