Anyone Here Have Access to a Lab Tech?

[futurehope]

I have just called Quest to ask if they have the name of the bacteria in the colonies on my report which reads:

Mixed urogenital flora, less than 10,000 CFU/mL isolated. No further testing performed.

I wanted to know if the colonies noted above have been identified? The lady receptionist refused to hand my call over to a tech person saying that MY DOCTOR has to explain this to me. I said, I do not want results: I just want a "yes" or a "no" if the colonies have been identified (yes) or not (no). I asked again to be handed over to a technical person who would understand my question, and she refused. I honestly do not think she knew what I was asking or saying. :mad:

She had no clue what I was talking about and refused to transfer my call to a technical person.

Thus, DOES ANYONE OUT THERE KNOW SOMEONE who is a technical person working for a lab that would answer this question?

Thanks. I do not want to bother my doctor and ask her to call Quest if they do not have additional info on my test specifying the identity of the colonies below 10,000 CFU/mL.

[ICNDonna]

I suggest you call your doctor's office. The nurse there can probably clarify for you.

Donna

[futurehope]

The secretary will pull out my report and read what I already saw. I wanted someone to call over to QUEST and find out if there is more info that is NOT on the report, specifically, what bacteria were in the colonies?

I know that my PCP will not get on the phone to ask this question of QUEST, esp. if they have not identified the colonies.

Therefore I wanted Quest to tell me first, whether there IS more info on the bacteria involved so that I could then ask the PCP to call and get the additional info. Anyhow, I will probably wait until November when I see my uro and really talk more with him about getting a clean catch with a catheter and sending it off for the Quest report that shows everything that turns up, no matter what the count.

I really want someone who is going to follow up on whatever is decided, such as treatment with abx, because I do not want any old antibiotic, I want the one that will kill the bacteria in my urine and I want to be on the abx for as short a period of time as to get me healthy and keep me there.

So, my uro is my best bet for that. I hope.

[futurehope]

The secy for my uro said that the standard urine culture result of less than 10,000 colony forming units does NOT identify those units.

She also said my doctor does not subscribe to or ask for broth cultures, nor does he concern himself with the low colony counts on standard cultures. He has not had success in treating IC patients with antibiotics (unless they have identifiable infections, I suppose).

FYI, my uro is a leading IC researcher.

[sphinx]

Usually a result of "mixed flora" means a contaminated culture....ie. the sample meant to be a "clean catch" (you know, cleaning with the swabby towels, peeing in the toilet first, then in the cup, etc) but accidentally you either don't clean well, or the cup touches something non-sterile, or even mis-handling at the lab. Ask your doctor to allow you to leave another specimen.

Even a supposed sterile urine from a catheter can be contaminated accidentally, although if done properly that is not likely to happen.

I'm sorry to hear that no one bothered to explain that to you:mad:

BTW, if anyone on here had access to your lab results somehow, it would be against the law for them to access them. I'm sure you've heard of HIPAA, you know those disclosure forms you have to fill out all the time when you see a new doctor? They are quite serious about this, and the company can be fined if the law is broken. I couldn't even look up my own labs if I wanted to, or those of my spouse, even if we did use the lab at the health service I work for. I would be fired at the minimum! I just thought you should know:)

[mich2604]

your PCP office is correct they will not report if it is under the count.

I had this issue when my bladder symptoms started in 1/06 i was peeing brown pieces, and they said it was Mixed urogenital flora, less than 10,000 CFU/mL isolated, just like you. My dr disagreed, but took me off antis anyway, and went looking for a vaginal infection, which it turns out i did have. I havent been the same since. I was even producing nitrites :-(

Im glad you were able to get an answer.

Do you think your Uro will order the quest culture that shows everything?

[Babs RN]

Yup, I second the information. Mixed flora means the urine is contaminated with epithelial skin cells, normal vaginal bacteria, bacteria from the moist towelette, the cup, the lid, your hands....and on and on and on...sphinx is right one. I also agree that it usually means another test is needed. Mixed flora usually also means not enough of any one of the particular bacteria colonies grew out to identify and locate sensitivity. I am just suggesting this based on my own personal experience and encourage you to talk with your physician as your true medical point of contact.

Hugs,
Barb:hi:

[futurehope]

Sphinx,
I think you misunderstood me and I think the person listening to my inquiry at the lab misunderstood me as well. I did not want my test results. I wanted to know IF the identity of the colonies < 10,000 CFU were known so that my physician could then call in to find them out?

Mich,

I will ask my physician if he thinks the Quest urine culture (via catheter) is worth it and what he would do if something shows up. The sec'y seemed very knowledgable (probably has to be intelligent because her boss is a researcher dealing with experimental programs), and when I asked her on the phone whether or not he ever does "clean catches" with a catheter, she said "sometimes".

We'll see.

[sphinx]

Sphinx,
I think you misunderstood me and I think the person listening to my inquiry at the lab misunderstood me as well. I did not want my test results. I wanted to know IF the identity of the colonies < 10,000 CFU were known so that my physician could then call in to find them out?



Hi...actually, I did understand you, but based on the title of your thread I wanted to put out an FYI to anyone out there that it is against the law to even look into a file of someone who is not directly under your care. Even if you didn't want "test results", just looking to see if your specific culture had identified the bacteria yes or no....that's a no-no too. I'm sorry if I worded that wrong.....

but regardless, in general.....it doesn't matter whether or not they identified the "mixed flora", because that result suggests that the sample was somehow contaminated. When they get preliminary results that suggest this, they won't bother identifying them, because it would be meaningless. The test needs to be repeated. I can tell you this without even knowing your specifics....I'm not a lab tech, but I am a nurse and I work in a clinic and obtain a lot of urine samples, and unfortunately get this type of result all too often. As soon as your doctor's office got this result, he should have had his office call you for another sample.

That's all I meant to say, sorry if I mis-spoke.:)

[MarthaF]

futurehope:

Please keep following up on this - testing is the key and we are trying very hard to find mainstream labs that will do better culturing than the "routine". We know United Medical Lab in McLean, VA will do broth (and they do the "routine" too and report the findings on both). But we know Quest has the ability to do a more extensive culture but it has been hard to find out what media they use and now you are having trouble finding out what bacteria they found. I know they are not accustomed to having patients call and ask these kinds of questions but we, chronic bladder symptom patients, have been forced to know more about bacteria in the urine than any of us ever wanted to know but have been forced to learn for our own health and the abiility to get good treatment.

I didn't know there was a difference between Gram negaitive (E. coli, Klebsiella, etc.) and Gram postitive (Enterococcous, Staph, Strep A, Strep B. etc.) before becoming symptomatic. These require different antibiotics and could come from different sources. The labs/doctors should know this and there should be communication between the two professions. The labs only identify them but they should do a sensitivity test so the MDs know which antibiotics to use.

My understanding is that Quest has regional labs for the testing of specimens and surrounding collection sites send these in to them. I called my regional lab in Baltimore and no technical person would speak to me. I have asked an RN patient in Houston to check with the regional lab there and haven't heard whether they have responded but hopefully they will explain more about their testing methods and reporting guidelines to her.

Whether something is a contaminant or a pathogen causing an actual infection is hard for any lab to know. Some species like Enterococcus (a form of Strep) does not usually grow the number of colonies that most labs consider an "infection", yet for some it may be a true pathogen and need treatment. It is not really up to the lab to determine that. Why not report this to the practitioner and let him/her decide.

I and a few others have had a report from United Medical returned saying "Mixed growth = negative". This was in the summer and we decided that sitting in a hot FedEx truck for hours enroute caused excessive growth and they could not culture correctly. Now in the summer I send with an ice pack. But they receive specimens from Singapore, New Zealand, etc, and can culture adequately so the distance does not matter if packaged correctly. If a pathogen was present when the collection was taken by the patient then it will still be there when it arrives. And if it wasn't there when collected it does not "spontaneously generate" en route.

I suffered for two years before having a broth culture and was found to have Enterococcus. My uro's lab had said "no growth" for two years so he did not give me even a trial of antibiotics. I reponded to the right antibiotic for Enterococcus so know that was my problem. But we know that Enterococcus and almost all bacteria can form biofilms in the bladder and hide from antibiotics, only to re-emerge later to cause anothe infection. Researchers are working on how to break up biofilms (BV is one instance of biofilms I know is being researched), so it is is not always as simple as a short course of antibiotics and you are "cured". Or bacteria can also become intracellular or go into a "viable but non-culturable state" making them hard to culture and to treat. There is much more research to be done and no one is saying this is just a UTI in the usual sense of the diagnosis. We don't know why some are susceptible since some can tolerate bacteria without symptoms. As I've said before, there are triggers and we have to try to figure out what they are.

But an important first start is good culturing and reporting so the MD knows what the patient is dealing with and decide whether to treat and, if so, what antibiotic to use with good information to start with.

Martha

[dbritts]

In my own case, I request copies of every single one of my medical tests. Because of the frustration of dealing with chronic enterococcal and MRSE, I wanted to be able to understand how to read a fluid resin culture. To make a long story short, my husband has access to the microbiology research unit at the AFB where he works. They went over my cultures (with my permission), not to give me medical advice, but to teach me how to read culture results.

Standard urine cultures will never identify staph or enterococcus. Why is it unreasonable to expect our urologists to order one culture that identifies all possible bacteria that can cause an UTI? Especially with the continued rise of infections caused by supergerms. It's not a question of IC vs. UTI--it's a question of doing one culture that will find any bacteria that can cause a UTI. A standard urine culture picks up e.coli because it causes 85% of UTIs, but that's not very helpful to the other 15% of us who are infected with something else.

I feel that having IC delayed getting a treatment plan that might have gotten rid of my infections. The mindset is that IC and bacteria don't mix--not true in my case!

Debbie

[futurehope]

My standard urine culture has since been repeated following my above-mentioned result of < 10,000 colony forming units. The first time, my PCP ordered the test.

This time, I've had my uro order the test and he added the "sensitivity" part of the test to determine the best antibiotic if needed.

I will let you know the results, but I bet you the test will again be negative.

I'll go pick up the results when available. I like to keep my medical tests in my own files for future reference and for showing to other doctors as needed.

My next official uro visit is in November, and at that time I would like the doctor to give his opinions of having me get the special Quest 3021A urine culture done via catheter.

Until then, my hydroxyzine HCl of 50 mg/night is keeping me rather functional, though I do not like how this medicine worsens my memory and increases my fatigue.

All for now, folks! :hi: Thanks for your input.