Urinary finding sought based on the clinical picture | Recommended test if an emergency laboratory is available or if a delayed response is sufficient | Rapid diagnosis at the treating unit if the delay of laboratory response is too long for the emergency process |
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* A negative response to a request for bacterial culture of urine may be given based on particle counting (rapid diagnosis). If so, the regional laboratory will have specified how the tests are technically combined, i.e. whether a separate request is needed for particle counting and whether the sample should be divided between two tubes. ** Usually not available out of hours. | ||
Bacteriuria | Particle counting and bacterial culture of urine* (from the same sample before medication) | Chemical screening and bacterial culture of urine* (from the same sample before medication) |
Pyuria | Particle counting and bacterial culture of urine* | Chemical screening and bacterial culture of urine* |
Haematuria | Particle counting of urine | Chemical screening of urine |
Proteinuria | Chemical screening of urine, in specific cases also ACR** (sensitive albuminuria) or urine protein** (immunoglobulin light chains) | Chemical screening of urine |
Glucosuria | Chemical screening of urine | Chemical screening of urine |
Ketonuria | Chemical screening of urine | Chemical screening of urine |
Urine concentration | Chemical screening of urine (relative density), included also in particle counting with flow cytometer, in specific cases osmolality of urine** | Chemical screening of urine |
Clinical presentation or way of urine collection | Limits for significant growth (CFU/ml) |
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* Growth at 103 -104 CFU/ml with 1-2 different bacterial species is significant if the patient has bladder symptoms and the specimen was collected properly (primary pathogens E. coli and Staphylococcus saprophyticus), or if an in-and-out catheter sample was cultured. An inoculum using a 10-µl loop is needed to detect 103 CFU/ml reproducibly, and a 100-µl loop to detect 102 CFU/ml (both equivalent to a minimum of 10 colonies on a plate). | |
Asymptomatic bacteriuria Catheter sample when changing indwelling catheter Suspected UTI, midstream specimen (no knowledge of the quality of urine collection) | 105 |
Suspected UTI, midstream specimen (good quality)* | 103 |
Catheter specimen from female/male patient (in-and-out catheterization) | 104 /103 |
Bladder puncture specimen, quantitative culture* | 102 |
Bladder puncture sample, enrichment culture | No limit |