Ordering, processing, and reporting urine cultures: Key points of the expert guidance

StageAppropriate practices
OrderingRequire documentation of proper (eg, clean-catch) collection
Only test patients with documented signs and symptoms of urinary tract infection
ProcessingUse a reflex-culture protocol when possible, so urine without inflammatory markers (ie, white blood cells) is not cultured, as this helps prevent microbial characterization and inappropriate treatment of asymptomatic bacteriuria
Do not routinely work up any isolates when more than 2 types of bacteria are recovered by culture
ReportingOptimize laboratory reporting:
  • Include a disclaimer that high colony counts can be present in asymptomatic bacteriuria

  • “Nudge” prescribers not to treat asymptomatic bacteriuria or mixed growth

  • Clearly define identified isolates as uropathogen or probable skin contaminant

  • Use antibiotic cascade reporting, which does not report fluoroquinolones as first-line antibiotics

  • Based on information in reference 1.