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View Full Version : Standard Urine Culture vs. Quest 3021A



futurehope
10-10-2007, 03:55 AM
FYI I called Quest Diagnostics this morning.

The standard urine culture (the one your doctor usually chooses), tests for isolates above the quantity considered "normal" for a "clean catch". If any bacteria, both positive or negative, show up above what they consider "normal flora", IT WILL BE REPORTED. This goes for gram positive or gram negative.

The urine, culture, special #3021A, tests for all isolates and in any quantity. It is supposed to be done with a catheter because they will report any and all bacteria in any quantity because they assume bacteria should not be in your bladder at all. Hence, the catheter, seems to be a necessary part of this test.

To sum up, she said that in the routine culture, they assume that the smaller quantity of isolates are contamination from normal flora in the genital area. I will go and pick up my routine culture results from my doctor today because they should mention the "normal" flora they found if there were any. They do not consider these a sign of infection.

She said these are the only two urine tests done by Quest and that they do NOT have a broth culture.

P.S. It was mentioned to me by another Quest person in another phone call, that the first morning specimen of catheterized urine will have the highest bacteria count, so, ideally, if doing a catheterization, get a first morning specimen. It has been in the bladder the longest time and will show more of what is growing in there.

MarthaF
10-10-2007, 05:05 AM
Another patient in Chicago had a Quest culture, #3021A, without a cath and it came back showing 3 bacteria. Her routine culture ordered by her gyn a day later did not show anything. Her NP ordered the Quest culture.

I know thay claim low colony counts are not infection, but certain species of bacteria , like Strep (Enterococcus) and Staph are Gram positive and any amount can cause infection in a compromised bladder. Think about it, when a kid goes in with a sore throat and they do a culture they do not do a colony count, the diagnose "Strep throat". Other infections caused by other than E. coli do not do a colony count.

People on here have reported the broth culture (no colony count) has found a treatable infection. Holly, for one, in an earlier post. Our research (unpublished) showed almost all controls had bacteria and if they have no symptoms then they can tolerate it. But if you have symptoms (a key) and bacteria of any amount it is worth following up. No one knows why some are susceptible to bacteria others can tolerate. Reseach shows that in the case of H.pylori which has been found to cause stomach ulcers is found in the stomachs of many, but only a percentage develop an ulcer. In most cases of infectious disease there is a "trigger" and they don't always know what it is. Could be the immune system, hormones, genetics, trauma, etc. Bacteria are than called "opportunistic" and take advantage. How can anyone say with certainty that 100,000 colonies of E. coli is an infection and 10,000 represents a contaminant. If there are symptoms that is a sign.

Routine cultures do not often find Enterococcus, and if they do the doctors consider it a contaminant. Some patients have found that it is indeed causing an infection. There is a test being developed at UCLA based on high level technology. In their abstract about it they point out all the species than can cause UTIs. Why would they go to the expense of developing a better type of urine testing if the current methods were satisfactory. There is no colony count involved.
http://jcm.asm.org/cgi/content/abstract/44/2/561
They announced this at the AUA meetings 2 years ago but apparently it isn't out in the clinics yet.

We know in the 21st century there has got to be better testing on the way! They started using the agar plate, routine, culture over 50 years ago.

futurehope
10-10-2007, 06:06 AM
Until the UCLA culture is in more widespread use, I can ask my uro to do a catheterization on urine (the longer it has been in the bladder, the better), and send it for the Quest #3021A. Quest said that for this test, they WILL tell you anything they find no matter what the count. (Also, my uro has not had success with long-term abx therapy for IC; I do not know what his protocol was in treating with abx, though.)

And on the subject of people with bacteria that have symptoms, I couldn't help but think of the people with recurrent throat infections and people with recurrent sinus infections. I guess, with the throat, they treat you with abx as best they can and remove your tonsils if they feel that would alleviate the situation. I've always felt sorry for the people with recurrent sinus infections. I know they can do some sinus surgery to widen the ducts that drain into the nose. The people with throat/sinus conditions can also become chronic and life-altering.

Obviously, doctors tend to rely on what they know and what they are the most comfortable in doing. And I'm sure no doctor wants to create other problems by doing something potentially harmful. For sure, there's room for more research for us IC people. I'm glad to hear that there are people who have been cured by the abx given over longer time. But, for me, I believe that there will eventually be other findings that better explain why the low grade infection persists and gives symptoms in the bladders of some people? Maybe we need to strengthen our immune system? Maybe our bladder lining needs to be regenerated? Maybe we suffer from a pathogen, as yet, unidentified? etc.

I do not want to tell anyone on this forum what to do or what not to do for their own individual situations. Each one of us needs to hear all the facts we can, and formulate our own course of action.

And, on that note, thanks for the input on the UCLA culture and for the info on the broth culture and for your input on this forum.

dbritts
10-10-2007, 08:57 PM
The diagnosis of UTI was once based on a quantitative urine culture yielding greater than 100,000 colony-forming units (105CFU) per milliliter of urine, which was termed "significant bacteriuria." This value was chosen because of its high specificity for the diagnosis of true infection, even in asymptomatic persons. However, several studies have established that one third or more of symptomatic women have CFU counts below this level (low-coliform-count infections). They have also shown that a bacterial count of 100 CFU per mL of urine has a high positive predictive value for cystitis in symptomatic women. Unfortunately, some clinical laboratories do not report counts of less than 10,000 CFU per mL of urine. As a result, low-coliform-count infections are not diagnosed by these laboratories.

Abstract

Complicated urinary tract infections (UTIs) are frequent nosocomial infections. The bacterial spectrum encompasses Gram-negative but also Gram-positive pathogens in up to 3040%. The existing treatment for Gram-positive pathogens is not always optimal. Antimicrobials for the treatment of Gram-positive uropathogens comprise older agents, such as aminopenicillins with or without β-lactamase inhibitors and vancomycin, as well as newer fluoroquinolones, such as levofloxacin or gatifloxacin. However, resistant bacteria such as vancomycin-resistant enterococci (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) (except vancomycin-resistant) are generally also not susceptible to the fluoroquinolones. Therefore new agents need to be assessed in the treatment of UTI. Daptomycin and linezolid are new antimicrobial agents with good efficacy against Gram-positive uropathogens as shown by their minimal inhibitory concentrations.
Volume 24, Supplement 1, September 2004, Pages 39-43
Proceedings of the 8th International Symposium on Clinical Evaluation of Drug Efficacy in Urinary Tract Infection


A positive nitrite test alone on dipstick while specific for UTI is only 30% sensitive. It should be noted that not all uropathogens reducenitrates to nitrite. For example, enterococci, S. saprophyticus and Acinetobacter species do not and therefore give false-negative results. In a patient with a high index of suspicion of UTI and a negative dipstick, direct examination of the urine and or nitrates to nitrite. For example, enterococci, S. saprophyticus and Acinetobacter species do not and therefore give false-negative results. In a patient with a high index of suspicion of UTI and a negative dipstick, direct examination of the urine and or culture must be done prior to excluding infection as the cause of the symptoms.

Cited from an article on complicated UTIs .

Last but not least--

[I]Clinical Enterococcal Infections

Enterococci, alone or with other enteric organisms, are relatively common causes of urinary tract infections, wound infections, and peritonitis and intra-abdominal abscesses. Enterococci have become an increasingly prominent cause of bacteremia,62 which usually originates from a focus in the urinary tract or abdomen; the incidence of nosocomial bacteremias caused by these organisms is also increasing, particularly in patients who have received cephalosporins or other broad-spectrum antibiotics. Enterococcal endocarditis may affect normal, diseased, or prosthetic valves and may pursue an acute destructive course. Enterococcal meningitis is much less common but may be very difficult to treat. Enterococcal infections are most common in persons with underlying genitourinary or GI disease, in the elderly, and in debilitated persons. Enterococci have become an important cause of disease in hospitalized patients; they are now the second most common nosocomial pathogen in the United States, occurring less commonly than Escherichia coli but more commonly than Pseudomonas aeruginosa and Staphylococcus aureus.

The entire article can be read at www.medcape.com/viewarticle/534777


This is a small sample of the information available through journal articles, abstracts and medical research. Some of this was published in 1994. Even if IC is taken out of the picture, why aren't women getting accurate detection and treatment for complicated UTIs in 2007?

futurehope
10-11-2007, 03:14 AM
Thanks for all your useful info esp. the article on infections with a low colony count. I will show these to my uro.

FYI

On my Quest report it reads...

CULTURE, URINE, ROUTINE-------
Mixed urogental flora, less than 10,000 CFU (colony forming units)/mL (milliliter) isolated. No further testing performed.

I called Quest yesterday to ask what these other smaller colonies were, and they refused to talk to me saying they would only talk about test results to a physician.

I think I will call them back and ask them if my PCP calls, will they be able to identify the bacteria in the colonies with less than 10,000 CFU/mL?

Maybe they do not even identify the stuff below 10,000 CFU/mL in this test?

Anyhow, I will definitely show the abstract about other "non-routine" infections to my uro in hopes that he will help me get to the bottom of this.

Thanks again.

jen74
10-11-2007, 06:17 AM
I was told by my gyne that any bacteria less than 100,000 they consider to be contamination. She did not agree with this though. I had a culture done back in March and it showed only 10,000 bacteria counts. My gyne said that usually doctors will not treat it as it is considered contamination. My gyne said that with a person with IC, it could very well be an infection since we tend to feel symptoms more quickly than a person with a normal bladder. She left it up to me, and said she would call in the antibitoics and I could take them if I felt I was getting worse. Well, I decided to wait since I had an appointment with a new urogyne at the time in three days. Well, I went there and left a sample and was still in alot of pain, but my urinalysis was normal, so they sent it off for a culture. Well, when I got the culture back three days later, I was found to have a huge amount of bacteria and had a full blown infection.
So when a person shows up with any small amount of one bacteria, it is likely the start of a infection. I would consider contamination if there was inconsistent numbers of more than one bacteria found, and even then, there is a possibility of infection going on. That is what I think.
Jen

dbritts
10-11-2007, 07:09 AM
Jen,
That was very well-said and agrees with the current medical information available.

Debbie

ejovan
10-17-2007, 08:16 AM
how would i go about getting a broth culture done by one of these labs.