Detecting Urinary Tract Infection (UTI)

How Urine Culture Candidates Reports streamline the UTI testing process

Estimated read time: 3 minutes

What Is a UTI?

A urinary tract infection, or UTI, is an infection that involves any part of the urinary system, including the urethra, bladder, ureters and kidneys.1 Urinary tract infections are the most common type of healthcare-associated infection reported to the CDC’s National Healthcare Safety Network.1 They lead to more antibiotic prescriptions following doctor visits than any other types of infection.2

UTIs place an economic burden on healthcare organizations. In the U.S., they account for over 100,000 hospitalizations at an annual cost of $1.6 billion.3

The facts about UTIs

  • About 150 million people develop UTIs in a given year4
  • UTIs occur eight times more often in women than men5
  • 50–60% of women report having had a UTI at some point in their lives6
  • In the U.S., one million emergency department (ED) visits per year are related to UTI7 
  • The economic burden in the ED for UTI treatment is estimated at $2 billion annually7
  • Approximately 15% of all community-prescribed antibiotics dispensed in the U.S. are for UTI;8 some European countries report similar findings9
  • About 25% of adult sepsis cases originate from urogenital tract infections, with most of these cases caused by complicated UTIs10

Supporting UTI Diagnosis with Urine Analyzer Results

UTI diagnosis is usually based on two tests, both of which require a urine sample.

  • Urinalysis, a screening test that provides information about the clarity and contents of urine, which includes the number of white blood cells, bacteria, leukocytes, nitrites and other parameters
  • Urine culture analysis, a test that helps to detect and identify bacteria in the sample, which can guide antibiotic treatment

How accurate lab UTI testing supports antimicrobial stewardship

Microbiology laboratories need rapid screening methods that can accurately detect bacteria in urine samples and support the administration of treatment. This need is highlighted by reports that about two-thirds of urine samples cultured will not yield any bacteria or will yield growth at levels too insignificant to indicate treatment.11,12

Antimicrobial stewardship involves the appropriate use of antibiotics. Effective antimicrobial stewardship is closely linked to the ability to diagnose infections, such as UTI. An excessive use of antibiotics is one of the contributing factors to antibiotic resistance, which has become a growing global public health concern.13 Saving lives by stopping the spread of antibiotic resistance requires aggressive action, according to the CDC. This includes improving antibiotic use to slow its development.14 

What automated urinalysis analyzers offer for UTI detection

Urine chemistry and microscopy analyzers can assist in laboratory prediction of urinary tract infection symptoms and indicators and help signal samples that need to be cultured.15 The main purpose of using automated urine analyzers is to reduce the number of samples unnecessarily subjected to urine culture. This helps to decrease test turnaround times and reduce patients’ financial burden.15

Streamlining the UTI Testing Workflow

Urine Culture Candidates Reports, available on the iQ Workcell automated urinalysis analyzer, is a tool that may offer insight into possible UTI. The reports are designed to streamline the UTI testing workflow by generating work lists of possible urinary tract infection patient sample values requiring review. The values are based on user-defined thresholds and indicate samples for possible release or reflex to microbiology for urine culture analysis. 

Urine Culture Candidates Reports display patient sample identification and a summary of combined urine chemistry and microscopy values, consistent with the Urine Culture Indicator Checklist:

  • Leukocyte esterase
  • Nitrites
  • White blood cells (WBCs)
  • Bacteria
  • All small particles (ASPs)

For applicable urinalysis microscopy instrumentation without direct connection to a urine chemistry analyzer, generated Urine Culture Candidates Reports include a summary of the following relevant microscopy values: 

  • WBCs
  • Bacteria
  • ASPs

Laboratory technologists can review the reports on the screen or print them out for future reference.

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1The Centers for Disease Control. “Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) and Other Urinary System Infection [USI]) Events.” www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf, January 2019. Accessed 15 Oct. 2019.
2Lee H and Le J. “Urinary Tract Infections.” PSAP 2018 BOOK 1: Infectious Diseases. American College of Clinical Pharmacy, 2018. 
3Simmering JE, Tang F, Cavanaugh JE et al.  “The Increase in Hospitalizations for Urinary Tract Infections and the Associated Costs in the United States, 1998–2011.” Open Forum Infect Dis, 2017, vol. 4, no. 1, p. ofw281. doi: 10.1093/ofid/ofw281.
4Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ.  “Urinary tract infections: epidemiology, mechanisms of infection and treatment options.” Nat Rev Microbiol, 2015, vol. 13, no. 5, pp. 269–284.
5Al-Badr A, and Al-Shaikh G. “Recurrent Urinary Tract Infections Management in Women.” SQU Med J, 2013, vol. 13, no. 3, pp. 359–367. doi: 10.12816/0003256.
6Rahn DD. “Urinary Tract Infections: Contemporary Management.” Urol Nurs, 2008, vol. 28, no. 5, pp. 333–342. 
7Abbo LM, Hooton TM. “Antimicrobial Stewardship and Urinary Tract Infections.” Antibiotics, 2014, vol. 3, no. 2, pp. 174 –192.
8Mazzulli T. “Resistance Trends in Urinary Tract Pathogens and Impact on Management.” J Urol, 2002, vol. 168, no. 4, pt. 2, pP. 1720–22. 
9The Medical Projects Agency, Sweden. “Lower Urinary Tract Infections (UTI” in Females—Treatment Recommendations.” 2007. 
10Wagenlehner FME, Lichtenstern C, Rolfes C et al. “Diagnosis and Management for Urosepsis.” Int J Urol. 2013, vol. 20, no. 10, doi: https://doi.org/10.1111/iju.12200. 
11Stürenburg E, Kramer J, Schön G et. al.  “Detection of Significant Bacteriuria by Use of the iQ200 Automated Urine Microscope.” JCM, 2014, vol. 52. pp. 2855–2860.
12Fok C, Fitzgerald MP, Turk T et al. “Reflex Testing of Male Urine Specimens Misses Few Positive Cultures May Reduce Unnecessary Testing of Normal Specimens.” Urol, 2010, vol. 75, no. 1, pp. 74–76. doi.org/10.1016/j.urology.2009.08.071.
13Aslam B, Wang W, Arshad MI et al. “Antibiotic Resistance: A Rundown of a Global Crisis.” Infect Drug Resist, 2018, vol. 11, pp. 1645–1658. doi: 10.2147/IDR.S173867.
14CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.
15Beckman Coulter. Instructions for Use - iQ200 Series. October 2017.