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      Clinical Utilization of Blood and Urine Cultures and Incidences of Bacteremia and Bacteriuria in a Hospital in Thailand

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          Abstract

          Background

          To effectively treat sepsis and urinary tract infection (UTI), blood and urine cultures should be used appropriately and relative to incidences of bacteremia and bacteriuria. This study aimed to investigate the use of blood and urine cultures and incidences of bacteremia and bacteriuria in a hospital in Thailand.

          Material/Methods

          Medical records of patients admitted from 2016 to 2018 were randomly selected and data in the records were anonymously extracted for investigation.

          Results

          From 12 000 records, data on blood and urine cultures were extracted from 9% and 4% of them, respectively. The negative rate of blood culture was 87.48%. Bacteremia was detected in 10.22%. The positive rate of urine culture was 27.38% and the contamination rate was 31.26%. Escherichia coli was the most common cause of community-onset bacteremia and bacteriuria. Methicillin-resistant coagulase-negative staphylococci and Acinetobacter baumannii were the most common cause of hospital-acquired bacteremia while yeasts were the most common cause of hospital-acquired UTI.

          Conclusions

          A high negative rate of blood culture may result not only from its low sensitivity but also from liberal test use to identify sepsis in some conditions. Improper urine collection is the main problem with use of urine culture.

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          Most cited references30

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          The Clinical Urine Culture: Enhanced Techniques Improve Detection of Clinically Relevant Microorganisms.

          Enhanced quantitative urine culture (EQUC) detects live microorganisms in the vast majority of urine specimens reported as "no growth" by the standard urine culture protocol. Here, we evaluated an expanded set of EQUC conditions (expanded-spectrum EQUC) to identify an optimal version that provides a more complete description of uropathogens in women experiencing urinary tract infection (UTI)-like symptoms. One hundred fifty adult urogynecology patient-participants were characterized using a self-completed validated UTI symptom assessment (UTISA) questionnaire and asked "Do you feel you have a UTI?" Women responding negatively were recruited into the no-UTI cohort, while women responding affirmatively were recruited into the UTI cohort; the latter cohort was reassessed with the UTISA questionnaire 3 to 7 days later. Baseline catheterized urine samples were plated using both standard urine culture and expanded-spectrum EQUC protocols: standard urine culture inoculated at 1 μl onto 2 agars incubated aerobically; expanded-spectrum EQUC inoculated at three different volumes of urine onto 7 combinations of agars and environments. Compared to expanded-spectrum EQUC, standard urine culture missed 67% of uropathogens overall and 50% in participants with severe urinary symptoms. Thirty-six percent of participants with missed uropathogens reported no symptom resolution after treatment by standard urine culture results. Optimal detection of uropathogens could be achieved using the following: 100 μl of urine plated onto blood (blood agar plate [BAP]), colistin-nalidixic acid (CNA), and MacConkey agars in 5% CO2 for 48 h. This streamlined EQUC protocol achieved 84% uropathogen detection relative to 33% detection by standard urine culture. The streamlined EQUC protocol improves detection of uropathogens that are likely relevant for symptomatic women, giving clinicians the opportunity to receive additional information not currently reported using standard urine culture techniques.
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            Laboratory diagnosis of urinary tract infections in adult patients.

            Urinary tract infections (UTIs) are among the most common bacterial infections and account for a significant part of the workload in clinical microbiology laboratories. Enteric bacteria (in particular, Escherichia coli) remain the most frequent cause of UTIs, although the distribution of pathogens that cause UTIs is changing. More important is the increase in resistance to some antimicrobial agents, particularly the resistance to trimethoprim-sulfamethoxazole seen in E. coli. Physicians distinguish UTIs from other diseases that have similar clinical presentations with use of a small number of tests, none of which, if used individually, have adequate sensitivity and specificity. Among the diagnostic tests, urinalysis is useful mainly for excluding bacteriuria. Urine culture may not be necessary as part of the evaluation of outpatients with uncomplicated UTIs, but it is necessary for outpatients who have recurrent UTIs, experience treatment failures, or have complicated UTIs, as well as for inpatients who develop UTIs.
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              Voided midstream urine culture and acute cystitis in premenopausal women.

              The cause of acute uncomplicated cystitis is determined on the basis of cultures of voided midstream urine, but few data guide the interpretation of such results, especially when gram-positive bacteria grow.
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                Author and article information

                Journal
                Med Sci Monit Basic Res
                Med Sci Monit Basic Res
                Medical Science Monitor Basic Research
                Medical Science Monitor Basic Research
                International Scientific Literature, Inc.
                2325-4394
                2325-4416
                2020
                29 June 2020
                : 26
                : e924204-1-e924204-8
                Affiliations
                Department of Pathology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
                Author notes
                Corresponding Author: Veeravan Lekskulchai, e-mail: veeravah@ 123456g.swu.ac.th
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                924204
                10.12659/MSMBR.924204
                7346747
                32595203
                065ef6c2-d8ee-49eb-bfed-c61c03c533c2
                © Med Sci Monit, 2020

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 11 March 2020
                : 19 May 2020
                Categories
                Clinical Research

                bacteremia,bacteriuria,clinical laboratory techniques,sepsis

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