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Ann Emerg Med. 1986 Mar;15(3):302-7.

Utility of urine cultures in the emergency department.


Urinary tract infection (UTI) is a common problem treated by emergency physicians. A midstream urine sample remains the most frequent method of culture collection. Although midstream urine culture growing more than 10(5) colony-forming units per milliliter (cfu/mL) has been considered diagnostic of UTI, high false-positive and false-negative rates as well as a lack of precision have been associated with this method of collection. Alternative methods of establishing the diagnosis of UTI have excellent sensitivity and may be utilized at the time of patient presentation. These include the detection of leukocyte esterase activity in urine and the presence of one or more bacteria on microscopic examination of an unspun urine sample. Women of child-bearing age represent the vast majority of patients seen with UTI. Uncomplicated infection of the urinary tract has a generally benign course in these patients, and is rarely associated with long-term complications. In addition, these patients are infected with a predictable spectrum of uropathogens that respond to the commonly used antibiotics. It appears that urine cultures provide little additional information in this patient population. Urine cultures should be obtained in patients at high risk for pyelonephritis or bacteremia/urosepsis, as well as in those expected to have uncommon or resistant organisms.

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