Uti

Urinary tract infections (UTIs) are common
infections that can affect the bladder, the
kidneys and the tubes connected to them.

What is urine:
 A watery, typically yellowish fluid stored in the
bladder and discharged through the urethra. It is one
of the body's chief means of eliminating excess water
and salt, and also contains nitrogen compounds such
as urea and other waste substances removed from the
blood by the kidneys.

Formation of urine:
 The kidneys filter unwanted substances from the blood
and produce urine to excrete them. There are three
main steps of urine formation: glomerular filtration,
reabsorption, and secretion. These processes ensure
that only waste and excess water are removed from
the body.

Collection of urine:
WHAT IS A URINE (MSU) TEST?
A midstream specimen of urine
(MSU) is tested to look for infection.
Symptoms of a urine passing urine frequently. However
symptoms are not always typical, particularly in
children and elderly.

HOW DO I OBTAIN A URINE (MSU)
SAMPLE?
If the doctor or nurse has asked you to do a midstream
specimen of urine, they will either provide you with a
sterile container to urinate into, or ask you to collect
a container from reception. A midstream sample
(urine from the middle of your bladder) is best as the
first bit of your urine that passes may be contaminated
with bacteria from the skin.

What is a percutaneous
nephrostomy (PCN)?
The ureter is a narrow tube that drains urine from the
kidney to the bladder. If the drainage of infected urine
is blocked due to a stone, blood clot, diabetic papilla
or fungal ball; then the patient has a propensity to go
into septic shock & surgical intervention may become
mandatory. Prior to a definitive intervention, the
patient needs to be stabilized by relieving the
blockage. For this a fine plastic tube is put through
the skin, into the kidney,

under general / local anesthesia.
This tube allows deobstruction of the
system & drains the
urine from the kidney into a
collecting bag, outside the body.
This procedure is called a
percutaneous (meaning through
the skin) nephrostomy
(a tube put into the kidney
through a small hole).
An iatrogenic injury or a diagnostic
study may also merit placing a PCN

TRANSPORTATION OF URINE
SPECIMEN:
Urine analysis is the diagnosis and treatment of
urinary tract infections and the detection of metabolic
disorders.
Accurate results depend on the collection methods,
container type,
transportation, and the handling
of the specimen.
The type of specimen and the
method of collection
varies and depends on the type
of test requested.

Routine Urinalysis:
Specimen should be collected in a clear, dry, clean
container with a tight fitting lid.
(If culture and sensitivity are also ordered, the
container should be sterile).
A regular voided specimen is acceptable for routine
urinalysis. However,
to avoid contamination of
the specimen,
a midstream collection is
preferable.

Urine Culture and Sensitivity:
Urine for C & S must be collected in a sterile
container. A midstream clean-catch collection
procedure ensures that the specimen is free of
contamination from external genital areas. Specimens
for C & S and other microbiological studies should be
transported at room temperature and processed within
2 hours of collection. Alternatively, specimens may be
refrigerated and processed within 24 hours. Also,
urine may be transported at room temperature in a
tube with preservative and processed within 24
hours. Urine culture transport tubes may be used if
there is a delay in processing.

URINE CULTURE:
A urine culture is a test to find germs (such as
bacteria) in the urine that can cause an
infection.Urine in the bladder is normally sterile.
This means it does not contain any bacteria or other
organisms (such as fungi)
But bacteria can enter
the urethra and cause a
urinary tract infection
(UTI).

Urine Culture Test:
A urine culture test involves collecting a urine sample
and keeping it under specific conditions that
encourage growth of bacteria or fungi. If the growth
of the organisms is minimal, it means that the test is
negative and there is no infection. However, if the
growth of organisms is excessive, it implies a positive
urine culture test and is indicative of a urinary tract
infection.

If the test is positive, then you may need to take some
other tests to determine the appropriate treatment or
medication to eliminate the infection. These tests are
called

Clead media for urine culture:
CLED agar (Cystine lactose electrolyte
deficient) For the cultivation
of gram-postitive and gram-negative
urinary tract bacteria.
CLED Agar is a non-selective differential
plating medium for the growth
and enumeration of
urinary tract microorganisms. Omitting sodium
chloride CLED Agar inhibits the swarming of
Proteus.

Reason Why It Is Conducted:
A urine culture test, as mentioned above, is conducted
mainly to determine the presence and cause of urinary
tract infection. It is also conducted to determine the
effectiveness of treatment administered for an
infection. Lastly, urine culture tests also help in
chalking out the appropriate treatment for urinary
infection.

Preparation:
There is no specific preparation for the urine culture
test. Being a urine test, it is best taken early in the
morning, preferably the first urine of the day should
be collected. All you need to ensure is that you
apprise your doctor about any antibiotics you are
taking or have taken in the recent past, as these
could affect the outcome of the test.

Procedure To Conduct The Test:
 Since you need to collect a urine sample, this is a self-
administered test. You will be given a container in
which you need to collect your urine sample. Now, it
is always advisable to collect your urine midstream,
i.e. you urinate for a couple of seconds or more before
placing the container under the stream for collection.
Since the outer skin of the genital area could contain
bacteria or other such organisms, ensure you don't let
the urine come in contact with the outer skin.
 Typically, it takes about 2 to 3 days to get the test
results, as the labs need to provide time for the
organisms to grow.

 Women can hold their skin apart while men can
retract the foreskin a little further to avoid contact.
Don't let the container touch your genital area as it
could lead to a transfer of bacteria into the lid. To
ensure accuracy of the test, it is advisable to wash
your genital area thoroughly or use a medicinal swab
to clean it before taking the test. Do remember to
wash your hands before and after collecting the urine
sample.
 Typically, it takes about 2 to 3 days to get the test
results, as the labs need to provide time for the
organisms to grow.

Results:
 A normal or negative test result means there is
minimal or no growth of bacteria or fungi in the
culture. A positive or abnormal culture test means
there has been growth of bacteria or fungi in the urine
culture. In general, 100.000 or more bacteria p/ml
(per milliliter) is indicative of an infection. Bacteria
presence ranging from 100 to 100,000 is believed to
be caused by contamination of a sample or could also
be an infection. Bacterial count below 100 falls in the
range of a negative culture result. Do note though,
that 100 or less bacteria per ml could also be caused
by intake of antibiotics.

 As mentioned earlier, in case of a positive urine
culture test, you need to take sensitivity tests to
determine the appropriate treatment.

Treatments and drugs:
 Antibiotics usually are the first line treatment for
urinary tract infections. Which drugs are prescribed
and for how long depend on your health condition and
the type of bacteria found in your urine.

Antibiotics:
 Simple infection
 Drugs commonly recommended for simple UTIs include:
 Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
 Fosfomycin (Monurol)
 Nitrofurantoin (Macrodantin, Macrobid)
 Ciprofloxacin (Cipro)
 Levofloxacin (Levaquin)
 Cephalexin (Keflex)
 Ceftriaxone (Rocephin)
 Azithromycin (Zithromax, Zmax)
 Doxycycline (Monodox, Vibramycin, others)

Uti

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