Interpretation of culture

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Interpretation of culture

Lima, Ohio US Pharm. Urinary tract infection UTI Interpretation of culture one of the most commonly diagnosed infections in both outpatient and inpatient populations.

In order to make an accurate diagnosis, it is essential for practitioners to understand the value and limitations of urinalysis and urine culture. Use of these tests in conjunction with an assessment of urinary symptoms will yield a diagnosis of either asymptomatic bacteriuria or symptomatic UTI.

Pharmacists can play a key role in recommending that antibiotic therapy be withheld when it is not indicated, in addition to providing guidance on appropriate antibiotic selection when treatment is warranted.

Urinalysis is a valuable diagnostic tool for many common disease states. Urinalysis is the most frequently used test for the evaluation of potential urinary tract infection UTI. In addition, it can provide useful information related to screening and diagnosis of other conditions, including malignancy, proteinuria, glycosuria, ketonuria, and renal calculi.

This article will focus primarily on the interpretation of urinalysis and subsequent urine culture in the diagnosis and treatment of UTIs. Overview UTI is the second most common type Interpretation of culture infection, accounting for approximately 10 million visits to health care providers in the United States each year.

However, because urinalysis is so commonly ordered in the emergency care setting, there is concern that misinterpretation may lead to overtreatment of UTI and increased antibiotic use.

Treatment of a UTI should never be initiated based upon urinalysis alone; patient history and subsequent urine culture results are extremely important for diagnosing UTI.

Clinical Presentation It is vital to understand the symptoms of UTI that may prompt an order for a urinalysis and urine culture. Urinary symptoms should be used in conjunction with test results to diagnose UTI. While many of the symptoms seem intuitive, there have been some recent changes to the definitions of the nonspecific symptoms that many health care providers have come to associate with UTI.

The most common symptoms associated with lower UTI include dysuria or acute pain, frequent urination, urgency, and incontinence. Occasionally, hematuria, cloudy urine, or foul-smelling urine may be present. Compared with cystitis, pyelonephritis often has a more severe, systemic presentation.

In addition to the urinary symptoms seen in cystitis, patients may also present with suprapubic pain, costovertebral angle tenderness flank painfever, chills, elevated WBC count, nausea, and vomiting.

Clinical Presentation

Nonspecific symptoms, most notably mental-status changes, have become associated with a suspicion of UTI in elderly patients. This can been attributed to the inclusion of these generalized symptoms in previous consensus-based criteria for diagnosing UTI in residents of skilled nursing facilities.

The most recent definitions of UTI in long-term care facilities do not include acute mental-status change as a symptom of UTI in noncatheterized patients.

In patients without an indwelling catheter, mental-status change or acute functional decline without an alternative diagnosis may be used as a diagnostic criterion for UTI, but only if leukocytosis is present as well.

Urinalysis Interpretation There are several factors to consider when evaluating urinalysis for indicators of infection. The most obvious indicator of bacterial infection in the urine is the presence of bacteria; this is often quantified in terms of the number of bacteria per high-power field HPF.

However, pyuria does not necessarily mean that the inflammation is a result of infection. A test that is positive for nitrites in the urine indicates the presence of an organism that reduces nitrate. A positive test is highly specific for bacterial infection, but a negative test does not exclude infection, giving this test low sensitivity.

Frequently, if any of the first four tests listed in TABLE 1 are positive, a reflex urine culture will be ordered. This can create a situation in which a positive urine culture may prompt treatment with antibiotics, even if the patient is asymptomatic. Overtreatment of asymptomatic bacteriuria is a common occurrence that can be prevented with careful application of guideline-based recommendations.

Approach to the Asymptomatic Patient A therapeutic challenge arises when a patient has urinalysis findings or culture results that are consistent with UTI, yet does not experience any urinary symptoms. The prevalence of this condition, known as asymptomatic bacteriuria, increases with age.

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Approach to the Symptomatic Patient Once a diagnosis of UTI has been made based upon symptoms and urinalysis results, the next step is to start empirical antibiotic therapy and await culture and susceptibility results.

As previously discussed, UTI symptoms may be defined as lower cystitisupper pyelonephritisor nonspecific. Another classification of UTI that can determine treatment and therapy duration is uncomplicated versus complicated.

Uncomplicated UTI in young males may be a result of homosexual activity or noncircumcision, but otherwise UTIs in men are often classified as complicated. The most common pathogen in uncomplicated infections is Escherichia coli, followed by other Enterobacteriaceae, including Proteus mirabilis, Klebsiella pneumoniae, and Staphylococcus saprophyticus.

In patients with complicated UTI, the same pathogens may be present; however, more resistance is seen with gram-negative organisms. Some of the most common resistant uropathogens are extended-spectrum beta-lactamases, which are common with E coli, K pneumoniae, and P mirabilis species.

Infections with gram-positive organisms such as staphylococci and enterococci are also more common in complicated UTI.Vous êtes: Accueil La Salle des habitants de Deschambault - Photo: Donald Vézina.

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Interpretation of culture

In my dream I was sleeping on the ground and awoke to see 3 or 4 shadows around me. The buffaloes were all standing and were at rest or grazing. US Pharm. ;38(11) ABSTRACT: Urinary tract infection (UTI) is one of the most commonly diagnosed infections in both outpatient and inpatient populations.

In order to make an accurate diagnosis, it is essential for practitioners to understand the value and limitations of urinalysis and. I read this meaning of dreaming with butterflies 2 days later I received news my brother was on his vacation and he had a fatal heart attack.

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