Outpatient urine culture: does collection technique matter?

BACKGROUND

Dysuria is one of the most common presenting complaints of young women, and urinalysis is one of the most common laboratory tests performed. Despite the fact that the midstream clean-catch technique is commonly used for urine collection, contaminated urine cultures occur with distressing regularity. The midstream clean-catch technique is time-consuming to explain, frequently not performed correctly by patients, costly for supplies, often embarrassing for patients and staff, and of unproven benefit. Therefore, we designed a study to compare various methods of obtaining specimens for culture from acutely dysuric young women.

METHODS

A total of 242 consecutive female patients who presented with symptoms suggestive of a urinary tract infection were randomized into 3 groups. The first group (n = 77) was instructed to urinate into a clean container. No cleansing was done, and the specimen was not obtained midstream. The second group (n = 84) was instructed to collect a midstream urine sample with perineal cleansing and spreading of the labia. In an attempt to decrease contamination from the vagina, the third group (n = 81) was given the same instructions as group 2, with the addition of using a vaginal tampon. Contamination rates were calculated for all 3 groups.

RESULTS

Contamination rates for the 3 groups were nearly identical (29%, 32%, and 31%, respectively). Comparing the no-cleansing group with the combined cleansing, midstream groups also showed no difference in contamination rates (28.6% and 31.5%, respectively, with P =.65).

CONCLUSIONS

In young, outpatient women with symptoms suggestive of a urinary tract infection, the midstream clean-catch technique does not decrease contamination rates.