Evaluation of the BD Vacutainer Plus Urine ... - Oxford Academic

The remainder of the urine sample was left in the original urine collection cup and was stored at 4°C (refrigerated nonpreservative urine [R-NPU]) ... SkiptoMainContent Advertisement SearchMenu Menu NavbarSearchFilter ThisissueAllAmericanJournalofClinicalPathology AllASCPJournalsAllJournals MobileMicrositeSearchTerm Search SignIn Issues MoreContent Advancearticles COVID-19articles Editor'sChoice CME/SAMArticles Submit AuthorGuidelines OpenAccess SubmissionSite Purchase Advertise AdvertisingandCorporateServices Advertising Mediakit ReprintsandePrints SponsoredSupplements BrandedBooks About AboutAmericanJournalofClinicalPathology AbouttheAmericanSocietyforClinicalPathology EditorialBoard Alerts Self-ArchivingPolicy Issues MoreContent Advancearticles COVID-19articles Editor'sChoice CME/SAMArticles Submit AuthorGuidelines OpenAccess SubmissionSite Purchase Advertise AdvertisingandCorporateServices Advertising Mediakit ReprintsandePrints SponsoredSupplements BrandedBooks About AboutAmericanJournalofClinicalPathology AbouttheAmericanSocietyforClinicalPathology EditorialBoard Alerts Self-ArchivingPolicy Close searchfilter Thisissue AllAmericanJournalofClinicalPathology AllASCPJournals AllJournals searchinput Search AdvancedSearch SearchMenu ArticleNavigation Closemobilesearchnavigation ArticleNavigation Volume140 Issue3 September2013 ArticleContents Abstract MaterialsandMethods Results Discussion References ArticleNavigation ArticleNavigation EvaluationoftheBDVacutainerPlusUrineC&SPreservativeTubesComparedWithNonpreservativeUrineSamplesStoredat4°CandRoomTemperature StephenW.Eisinger,MS, StephenW.Eisinger,MS 1JohnsHopkinsUniversity,SchoolofMedicine,DepartmentofPathology,DivisionofMicrobiology,Baltimore,MD Searchforotherworksbythisauthoron: OxfordAcademic GoogleScholar MatthewSchwartz,M(ASCP), MatthewSchwartz,M(ASCP) 2JohnsHopkinsBayviewMedicalCenter,DepartmentofPathology,Baltimore Searchforotherworksbythisauthoron: OxfordAcademic GoogleScholar LisaDam,MT(ASCP), LisaDam,MT(ASCP) 2JohnsHopkinsBayviewMedicalCenter,DepartmentofPathology,Baltimore Searchforotherworksbythisauthoron: OxfordAcademic GoogleScholar StefanRiedel,MD,PhD StefanRiedel,MD,PhD 1JohnsHopkinsUniversity,SchoolofMedicine,DepartmentofPathology,DivisionofMicrobiology,Baltimore,MD2JohnsHopkinsBayviewMedicalCenter,DepartmentofPathology,Baltimore Searchforotherworksbythisauthoron: OxfordAcademic GoogleScholar Presentedinpartatthe111thGeneralMeetingoftheAmericanSocietyforMicrobiology;May2011;NewOrleans,LA. AuthorNotes AmericanJournalofClinicalPathology,Volume140,Issue3,September2013,Pages306–313,https://doi.org/10.1309/AJCP5ON9JHXVNQOD Published: 09January2013 PDF SplitView Views Articlecontents Figures&tables Video Audio SupplementaryData Cite Cite StephenW.Eisinger,MS,MatthewSchwartz,M(ASCP),LisaDam,MT(ASCP),StefanRiedel,MD,PhD,EvaluationoftheBDVacutainerPlusUrineC&SPreservativeTubesComparedWithNonpreservativeUrineSamplesStoredat4°CandRoomTemperature,AmericanJournalofClinicalPathology,Volume140,Issue3,September2013,Pages306–313,https://doi.org/10.1309/AJCP5ON9JHXVNQOD SelectFormat Selectformat .ris(Mendeley,Papers,Zotero) .enw(EndNote) .bibtex(BibTex) .txt(Medlars,RefWorks) Downloadcitation Close PermissionsIcon Permissions Share Email Twitter Facebook More NavbarSearchFilter ThisissueAllAmericanJournalofClinicalPathology AllASCPJournalsAllJournals MobileMicrositeSearchTerm Search SignIn Close searchfilter Thisissue AllAmericanJournalofClinicalPathology AllASCPJournals AllJournals searchinput Search AdvancedSearch SearchMenu Abstract Objectives:Thestabilityofurinespecimenssubmittedforcultureremainsachallengeformanylaboratoriesbecauseofdelaysinspecimentransport.WeevaluatedtheusefulnessofBDVacutainerPlusUrineC&SPreservativeTubeinensuringspecimenstability.Methods:Clinicalurinespecimenscollectedinsterilecollectioncups(n=110)wereplatedontosheepbloodandMacConkeyagarfollowingstandardlaboratoryproceduresguidelines.Thereafter,specimensweredividedinto3storageconditions:nonpreservative,refrigerated;nonpreservative,roomtemperature(RT);BDVacutainerPlusUrineC&SPreservativeTube,RT.Foreachsampletype,additionalculturesweresetupat2,4,24,and48hours.Results:Initially,18specimenshadnogrowth,32showedmixedskinflora,and60yieldedatleast1uropathogen.IncreasedcolonycountsofuropathogenswereobservedfornonpreservedurinesamplesstoredatRT;thesechangeswerestatisticallysignificant.MinordifferencesbetweenrefrigeratedurinesamplesandBDVacutainerPlusUrineC&SPreservativeTubesampleswereseenbutwerenotstatisticallysignificant.Conclusions:Theuseofpreservative-containingcollectiontubesisdesirabletoensurespecimenstabilitywhenpromptprocessingorrefrigerationisnotfeasible. Urinarytractinfections(UTIs)areamongthemostcommonlyencounteredinfectiousdiseases,andurinespecimenssubmittedforquantitativebacterialcultureaccountforasignificantlylargevolumeoftestrequestsinclinicalmicrobiologylaboratories.1–4ThegoldstandardfordiagnosisofaUTIisthedetectionofaurinarypathogenviacultureinfreshlycollectedurinespecimens.3,4Typically,patientsareaskedtoprovidea“clean-catch,”midstreamurinespecimen.Otherspecimentypesmayincludethoseobtainedfromacatheter(single,straightcatheter,orFoleycatheter)orfromasuprapubicaspirationofthebladder.Consideringthehumananatomyoftheurinarytract,itisnotsurprisingthatUTIsareamongthemostcommonbacterialinfections.1–3However,voidedurinesamplesarefrequentlycontaminatedbyorganismsoftheurethral,skin,genital,and/orfecalflora.Theimportanceofappropriatespecimencollectionandtransporttoavoidcontaminationhasbeenpreviouslydescribed.4–7Usually,contaminantorganismsarepresentinlownumbers,ie,lessthan104colony-formingunits(CFU)/mL,whereasuropathogensarepresentinsignificantlyhighernumbers,usuallygreaterthan105CFU/mL.However,overtime,evencontaminantmicroorganismscangrowtosignificantlyhighnumberswhenspecimensareleftatroomtemperature(>15°C).Theeffectsofdelayedurinecultureaswellasimpactofvarioustransportandstorageconditionshavebeendescribed.8–11Thecurrentguidelinesforurinecollection,transport,andcultureemphasizetheneedforusingeithertransporttubescontainingpreservativesortheneedfornotexceedingthe2-hourintervalfromcollectiontoprocessing.4Ifpreservativetubesarenotusedandatransporttimeoflessthan2hoursmaynotbeachievable,refrigerationoftheurinespecimenhasbeenshowntoalsolimittheovergrowthoforganisms;however,itisunrealistictoexpectthatnourinespecimenwillspendmorethan2cumulativehoursunrefrigeratedinmostsettings.9Inthe2005CollegeofAmericanPathologists(CAP)Q-Probesstudyonurineculturecontamination,theinvestigatorsfoundthatonlyasmallnumberofmicrobiologylaboratoriesenforcethe2-hourcutoffruleforlimitingtransporttimeofurinespecimens.12Becausemostoftheevidenceonspecimenintegrityforurineisbasedonstudiesperformedinthe1980s,andconsideringthatintheCAPQ-Probesstudymostlaboratorysitesusedrefrigerationofurinespecimenforpreservation,wedecidedtoinvestigatetheusefulnessoftheBDVacutainerPlusUrineC&SPreservativeTube(BDU;BectonDickinson,FranklinLakes,NJ)andcompareitsperformancetorefrigeratednonpreservativeandroom-temperature–exposednonpreservativeurinespecimens.ThisstudyfurtheraimedatassessingstabilityofboththespecimenandCFUcountsovertime.MaterialsandMethods ThisresearchwasapprovedbytheinstitutionalreviewboardoftheJohnsHopkinsMedicalInstitutions(Baltimore,MD).BetweenDecember2010andAugust2011,patienturinesamplesfrom2medicalunitsandtheemergencydepartmentatourtertiarycaremedicalcenterwerescreeneduponreceiptinthemicrobiologylaboratoryusingamanualdipstickmethodforurinalysis(UA)(Multistix-10-SG,SiemensHealthcareDiagnostics,Tarrytown,NY)forpotentialenrollmentinthisstudy.Allurinespecimenswerecollectedandinitiallyreceivedinsterilecollectioncups,andspecimenswithavolumeinexcessof8to10mLwereconsideredaspotentialcandidatespecimens.Demographicpatientdataandthetimefromspecimencollectiontoreceiptinthelaboratorywererecorded.BasedontheUAresults,specimenslikelytoyieldpositiveculturesaswellasnegativeurinesampleswereenrolled.Atotalof110urinespecimenswereenrolledinthisstudy.ThesespecimenswerecollectedusingthesterilecollectioncupfromtheBDVacutainer“UrineCompleteCupKit”collectionsystem(BectonDickinson).Cultureswereperformedoneachoftheseinitialurinespecimensusinga0.01-mLinoculationloop,usingstreakplatemethodonatrypticasesoy(TSAII)with5%sheepbloodagar(SBA)andaMacConkeyagar(BectonDickinson,Sparks,MD).ThisculturewasconsideredtheT0(reference)cultureforall3subsequentspecimenstorageconditions.AftersettinguptheT0culture,urinewasdrawnfromtheBDcollectioncupinto1preservative-freeBDVacutainerUrinalysisPlusConicalUrineTube,NoAdditive,and1BDU.Theremainderoftheurinesamplewasleftintheoriginalurinecollectioncupandwasstoredat4°C(refrigeratednonpreservativeurine[R-NPU]).Theother2specimentubes,BDUandtheBDVacutainerUrinalysisPlusConicalUrineTube,NoAdditive(roomtemperaturenonpreservativeurine[RT-NPU])werestoredatroomtemperatureinthelaboratoryforthedurationofthestudy.Inadditiontotheinitialculture(T0),cultureswereperformedat2(T1),4(T2),24(T3),and48(T4)hours.Furthermore,ateachtimepointT1toT4,urinefromtheBDUaswellasthenonpreservativespecimens(R-NPUandRT-NPU)wasseriallydilutedat1:100and1:10,000using5mLof0.9%sterilesaline,andthencultureswereperformedonSBAusinga0.01-mLinoculationloop.AllurinespecimenswerereturnedtotheirrespectivestorageconditionsbetweenthetimepointsT1toT4forculture.Allcultureswereperformedaccordingtostandardlaboratoryproceduresandguidelines.4,13Inoculatedagarplateswereincubatedfor20to24hoursat35°CbeforetheywereassessedforgrowthandCFUcountsdetermined.Inplateswithpositivegrowth,theorganismwasidentifiedusingstandardandapprovedmethodsinourclinicallaboratory.Bacterialgrowthonagarplateswasclassifiedaccordingtocommonlyacceptedcategoricalassessmentforurinecultures:(1)negative,(2)mixedskinflora(MSF)only;and(3)uropathogen,regardlessofadditionalpresenceofMSF.TheCFUcountswereassessedandclassifiedasfollows:0CFU/mL,negative;greaterthan0tolessthan104CFU/mL,insignificantgrowth;104to105CFU/mL,positiveforUTIifuropathogenpresent;andgreaterthan105CFU/mL,positiveforUTI.StatisticalanalysisusingdescriptivestatisticalmethodswasperformedusingSTATA11software(StataCorp,CollegeStation,TX).Results Atotalof110urinespecimenswereincludedinthisstudy.Seventy-foururinesampleswereobtainedfromfemalepatients(67%)and36urinesampleswerefrommalepatients(33%).Patientsrangedinagefrom17to95years,withanaverageageof57years.Theaveragetimebetweenthecollectionoftheurinespecimenanditsarrivalinthelaboratorywas25minutes(range,5–70minutes).AtT0,18specimenshadnogrowthofanyorganisms,32exhibitedgrowthofonlyMSF,and60grewatleast1potentiallypathogenicorganismaloneorincombinationwithMSForanotherpathogen.Thefollowinggram-negativeorganisms(totalnumberofcultureswiththisorganism)wererecoveredoverthe48-hourstudyperiod:Escherichiacoli(n=32),Klebsiellapneumoniae(n=15),Proteusmirabilis(n=7),Enterobactercloacae(n=6),Pseudomonasaeruginosa(n=2),Citrobacterfreundii(n=1),Klebsiellaoxytoca(n=1),Shigellaspecies(n=1),Raoultellaornithinolytica(n=1),Gardnerellavaginalis(n=1).Inaddition,8cultureswerepositiveforyeast,includingCandidaalbicans(n=2),Candidaparapsilosis(n=2),Candidatropicalis(n=2),andCandidaspecies,notfurtherspecified(n=2).ThirteencultureswerepositiveforEnterococcusspecies,and10cultureswerepositiveforvariousgram-positivecocci,includingStaphylococcussaprophyticus,othercoagulase-negativestaphylococci,groupBstreptococci,andviridansgroupstreptococci.AllorganismswereidentifiedusingstandardidentificationmethodsapprovedbytheClinicalandLaboratoryStandardsInstituteandtheFoodandDrugAdministration,whicharecommonlyusedinclinicalmicrobiologylaboratories.ThecultureresultsbycategoricalanalysisforallspecimensoveralltimepointsaresummarizedinTable1.Differencesinthenumberofspecimenswithmorethan105CFU/mLpathogens(range,33–36)betweentherefrigeratedurinespecimensandtheBDUsamplesandbetweenthetimepointsT0andT3(24h)werenotstatisticallysignificant.Similarly,nostatisticallysignificantdifferencewasseeninthenumberofcultureswithmorethanorequalto104pathogensbutlessthan105CFU/mLbetweenT0andT3fortheBDUandR-NPUsamples.Bycontrast,thenumbersofcultureshavingmorethan105CFU/mLpathogensinthenonpreservativeurinespecimenthatwasstoredatroomtemperature(RT-NPU)changedsignificantlyby24hoursaftercollectionwiththenumberofspecimenshavingmorethan105CFU/mLpathogensincreasingfrom35to70.Duringthesameperiod(T0–T3),thenumberofspecimenswith104CFU/mLpathogensbutlessthan105CFU/mLdecreasedfrom10to4fortheRT-NPUstoragecondition.Extendingthewindowofobservationtoa48-hourperiod,thenumberofsampleswithpathogensatT0(n=60)increasedto81intheRT-NPUgroup,61R-NPUsamples,and63BDUsamples.AlthoughthechangesfortheR-NPUandBDUsampleswerenotstatisticallysignificant,thechangesfortheRT-NPUsamplesweresignificant(P<.001 table1categoricalchangesofquantitativeurineculturesfromreferenceculture openinnewtab table2categoricalchangesofquantitativeurineculturesforno-growth resultsforallculturesbasedonstorageconditionwerefurtheranalyzedwithregardtowhetherthecultureresultwo uldbeconsideredclinicallysignificant table3categoricalchangesofquantitativeurineculturesfromreferenceculturewithmsf table4changesofclinicalsignificanceofquantitativeurineculturesfromreferenceculture discussion urinehaslongbeenrecognizedasanexcellentculturemedium.severalstudiesduringthe1970sandearly1980sinvest igatedtheeffectsofdelayedtransportandcultureonsemiquantitativeurinecultureresults.7 table5comparisonoftheeffectsofvariousurinetransport theresultsofourstudysupportthefindingsofthesepreviousstudiesthaturinespecimensarefairlystableatroomt emperatureforupto2hoursaftercollection>104CFU/mL)forauropathogen.AfterstorageoftheBDUpreservativeurinesamplesfor48hours(T4)atroomtemperature,culturesyieldeda44%positivityrate;thischangeinpositivityratewasnotstatisticallysignificant.Duringthesameperiod,unpreservedbutotherwiseidenticalurinesamplesstoredatroomtemperaturechangedfromtheinitial41%to71%,resultinginanincreasein“falsepositives,”andurinesamplesstoredat4°Cdecreasedfrom41%to40%.TherewasnostatisticallysignificantdifferenceintheresultsbetweenT0andT4forrefrigerated(R-NPU)orpreserved(BDU)urinesampleswithregardtonegativeculturesorcultureswiththepresenceofMSF.Laueretal9evaluatedtheeffectsof2differenturinepreservativefluids,includingboricacid,overa24-hourperiod;however,theseinvestigatorswereleftwith2unansweredquestions:(1)Doesboricacidhaveatoxiceffectforparticularbacterialspecies,and(2)Whatistheeffectofthepreservativebeyondthefirst24-hourintervalafterspecimencollection?Studieshavesuggestedthatboricacidmayhaveatoxiceffectonmicroorganismspresentinurinesamplesstoredforprolongedintervals(eg,≥24hours),resultinginanincreaseinnegativecultureresults.However,wedidnotidentifyanysignificantincreaseinthenumberofnegativeculturesafterstoragefor24or48hoursforanytypeofurinesample(16%atT0,17%forBDUatT4,and18%forR-NPUatT4).9,10AlthoughLumandMeers10usedaconcentrationof20g/Lofboricacidfortheirexperiments(0.5gboricacidintubesfilledwith25mLofurine)andLaueretal9usedamixtureofboricacid,glycerol,andsodiumformateinaglasstubefilledwith4to6mLofurine,theBDUsusedinourstudyareplastictubeswithboricacid,sodiumformate,andsodiumborate,filledwith4mLofurine.Consideringtheresultsofthesestudies,itappearsplausiblethatpureboricacidislikelytohaveaninhibitoryeffectonthegrowthofbacterialmicro-organisms,whilepreservativeformulationsusingsomeformofbufferedboricacidmaynotexertthisinhibitoryeffectonbacterialgrowth.Hubbardetal17reportedanoverall10%fewerpositivityratewithBDUspecimenscomparedwithrefrigeratedurinespecimens.FollowingasuggestionbyGuentherandWashington16thatspecimensyieldingmorethan104CFU/mLshouldbeconsideredequivalenttomorethan105CFU/mLwhenBDUswereused,Hubbardetal17suggestedthatthisapproachcouldeliminatetheproblemsassociatedwithfalse-negativeurinecultureresultswhenusingtheBDUsandprolongedstorageofspecimens(≥24hours).However,ourstudyresultsdidnotconfirmthesefindingsandresultsofcategoricalassessmentofurineculturesaswellassemiquantitativeassessmentwithR-NPUsamples.However,thesestudieshavesomedifferencesthatmustbeconsidered.Hubbardetal17usedglasstubesforurinecollection,whichcontainedaslightlydifferentpreservative,comparedwiththeplastictubeswithbufferedboricacidthatwereusedinourstudy.Furthermore,consideringpotentialdifferencesinthresholds(>104vs>105CFU/mL)usedbyvariouslaboratoriesforascribingclinicalsignificance,wechoseamostconservativeapproachforouranalysis,usingathresholdofmorethan104CFU/mL.TherewasastatisticallyhighlysignificantchangeinascribingsignificancetocultureresultsforurinespecimensintheRT-NPUgroup,particularlyforspecimensprocessedmorethan4hoursaftersamplecollection.However,nostatisticallysignificantchangeswereobservedforspecimensintheBDUandR-NPUgroupsforallintervalsthroughoutthisstudy.Sofarwefocusedonthequalitativeassessmentofurinecultureresults,whichisimportantwithregardtothepresenceand/orabsenceofuropathogensandtheoccurrenceofchangesinMSFand/orpathogenspresentinurinecultures.However,wealsoinvestigatedwhetherthepreservativeintheBDUsmayhaveaneffectonthecolonycountsovertimecomparedwithcorrespondingRT-NPUandR-NPUurinesamples.Intheir1981clinicalstudy,GuentherandWashington16reportedadeclineincolonycountsinurinespecimensusingtheBDUswhenspecimenswerestoredfor24hours.Furthermore,theseinvestigatorsproposedthat104ormoreCFU/mLinurinepreservedfor24hoursshouldbeconsideredequivalentto105ormoreCFU/mLinfreshlycollectedorrefrigeratedurine.Predicatedonthisassumption,therewasatleast98%agreementbetweeninitialurineculturesyielding105ormoreCFU/mLandpreservativeurineculturesat24hours.However,ofthespecimenscontaining104to105CFU/mLintheinitialculture,onlyone-thirdyieldedlessthan104CFU/mLinurinespecimenspreservedfor24hoursandwouldthenhavebeenconsideredas“negative.”Toourknowledge,only2studieshavebeenpublishedtodatethatinvestigatedthestabilityofcolonycountsovertime.16,19Inanotherstudy,Weinstein20demonstratedalackoftoxicityoflyophilizedbufferedboricacid.Furthermore,hefoundnodifferenceinquantitativeurinecultureresultsbetweenspecimensinpreservative-containingurinecollectiontubeskeptatroomtemperatureandspecimensinconventionalsterilecupsrefrigeratedduringtheholdingperiodof18to24hours.ContrarytotheresultsofGuentherandWashington16butsimilartothoseofWeinstein,wedidnotfindasignificantdeclineincolonycountsinurinesamplespreservedintheBDUscomparedwiththeinitialurinecultureresults(Table5).Theminorchangesincolonycountsobservedinbothrefrigeratedandpreservedurinespecimenswerenotstatisticallysignificant.Furthermore,weextendedthetimeforcultureandcolonycountcomparisonto48hoursafterspecimencollectionandagaindidnotseestatisticallysignificantchangesincolonycountsforeithertypeofurinespecimen.Basedonourstudyresults,itappearsnotnecessarytoexerciseparticularcautionwheninterpretingthecultureresultsandcolonycountsforurinesamplespreservedfor24hours.However,onemustconsiderthatourstudywasperformedunderthemostidealofconditions,thatis,urinesampleswererapidlytransportedtothelaboratory(averagetransporttime,25min),andsamplesintheR-NPUgroupwerekeptconstantlyat4°Crefrigeration,withtheexceptionofthetimeforinoculatingagarplates.Allsamplesandcultureswereprocessedunderstrictclean/asepticconditionstoavoidexternalcontaminationduringtheprocess.Inthe2005CAPQ-Probesstudyonurineculturecontamination,theinvestigatorsfoundthatonlyasmallnumberofmicrobiologylaboratoriesenforcethe2-hourcutoffruleforlimitingtransporttimeofurinespecimens.12Theinvestigatorsfoundthat90%ofthespecimensinthesurveyedlaboratorieswerereceivedwithin9hours.Althoughthemajorityoftheselaboratoriesprocessedurinespecimensthroughacentralreceivingarea,only35%oftheselaboratoriesrefrigeratedthespecimensbeforeorduringtheprocessing.Thedatashowedthatevenagreaternumberofsites,bothadjacentandnonadjacenttoalaboratory,donotconsistentlyrefrigerateurinespecimensbeforetransportingthemtothelaboratory.Numerousstudiesinthepasthavedemonstratedthatmosturinespecimenssubmittedformicrobiologicanalysisandcultureareeithernegativeorcontainamixedurogenitalfloraatlowcolonycounts(<104CFU/mL).5,8,9,12,16,17Astheresultsofthesepreviousstudiesandourcurrentstudyhavedemonstrated,colonycountsandcategoricalassessmentofurinespecimensremainstablewithinthefirst2hours.Someoftheseearlierstudiesdescribeddifferencesinurinecultureinterpretationandcolonycountsbetweenrefrigeratedurinesamplesandurinesamplescontainingpreservativemedia(suchasboricacid).Inthecurrentstudy,however,wedidnotidentifystatisticallysignificantdifferencesbetweenthesetypesofurinesamplepreservationmethods.TheresultsoftheCAPQ-Probesstudyleadustoquestiontheaccuracyoftheassumptionthatpatients’urinesamplesarecontinuouslykeptat4°C(refrigeration)fromthetimeofcollectiontothetimeofprocessinginthelaboratory.Itisthereforeunlikelythaturinespecimenswillbecontinuouslyrefrigeratedfromthetimeofcollectiontothetimeofculturesetupinroutineclinicalandlaboratorysettings.Theresultsofourstudydemonstratethatbacterialgrowthinurinesampleswillsignificantlychangeevenafterashortperiodofexposuretoambient/roomtemperatureduringspecimentransport.Consideringtheseconstraintsofeverydayclinicalandlaboratorypractice,theuseofsomeformofpreservative,suchasthebufferedboricacid,asanadditivetourinecollectiontubesishighlydesirableandshouldperhapsbeevenmandatoryforspecimenssentfromadistantspecimencollectionsite.Moststudies,includingthepresentstudy,demonstratethatthemajorityofurinespecimenssentformicrobiologicexaminationandculturewillbenegativeforgrowth,showsomegrowthofmixedurogenitalflora,oratbestarepositiveforauropathogenatsignificantlylessthan104CFU/mL,thelatteroftennotbeingconsideredindicativeofaUTIbutratherbeingcontaminatedduringthespecimencollectionprocess.1–3Ifsuchnonpreservedurinespecimensweretopresent,however,withhighercolonycountsbecauseofdelaysinspecimentransportandprocessingandifthefalse-positiveratecouldbeinexcessof15%assuggestedbytheCAPQ-Probesstudy,reportingoftheseurinecultureresultswouldhavesignificantimplicationsonpatientcare,antibioticuse,andothereconomichealthcare–relatedcost.Thepresentstudyhassomelimitations.First,urinespecimenswerenotprocessedforcultureattimepointsbetween4and24hoursaftersamplecollection.Manyofthechangesincolonycountsandcategoricalassessmentoccurredduringthisperiod,anditmayhavebeenhelpfultobetterunderstandthetimelysequenceofthesechanges.Second,theoverallnumberofurinespecimensincludedislimited,andtheorganismsthatcauseUTIslessfrequently,eg,Paeruginosa,werenotincludedinthisstudyinsignificantnumberstoallowforamoredetailedand/ororganism-specificanalysis.Finally,thecomparisonamongvariousstudiesthatinvestigatedtheusefulnessofpreservativesinurinecollectionsystemsislimitedbythefactthatthevariouspreservativesusedinthesestudiesmaybeinherentlydifferent(eg,boricacidvsbufferedboricacid)orthatsimplydifferenttypesofcollectiontubes(glassvsplastic)wereused.Inconclusion,theBDUisaneffectiveapproachformaintainingthequalitativeaswellassemiquantitativeassessmentofurinespecimensforcultureforupto48hoursafterspecimencollection.Theresultsofthepreservedurinesampleswereequaland/orbetterthanthoseusingtheapproachofrefrigeration.Promptplatingorevenpromptandconsistentrefrigerationofurinespecimenscannotbeassuredinmostroutineclinicalandlaboratorysettings.Thereforetheuseofurinecollectionandtransporttubescontainingapreservativesuchasbufferedboricacidishighlyrecommendedandshouldperhapsbemandatorywhenspecimensaresentfromadistantcollectionsiteorroutinelyexceeda2-hourspecimentransporttime.ThisstudywassupportedinpartbyBectonDickinson,FranklinLakes,NJ.DrRiedelreceivedresearchfundingfromBectonDickinson.References 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Weinstein MP .Clinicalevaluationofaurinetransportkitwithlyophilizedpreservativeforculture,urinalysis,andsedimentmicroscopy.DiagnMicrobiolInfectDis.1985;3:501–508.GoogleScholarCrossrefSearchADSPubMedWorldCat  Authornotes Presentedinpartatthe111thGeneralMeetingoftheAmericanSocietyforMicrobiology;May2011;NewOrleans,LA.©AmericanSocietyforClinicalPathology IssueSection: OriginalArticles Downloadallslides Advertisement 6,596 Views 12 Citations ViewMetrics × Emailalerts Articleactivityalert Newissuealert ReceiveexclusiveoffersandupdatesfromOxfordAcademic Moreonthistopic PerformanceofaUrine-ScreeningProtocol QuantitativeUrineCulture:AnAttempttoPreservetheStatusQuoofBacterialCountsinUrineSamplesbytheuseofDisodiumCalciumEdathamil UrineScreeningStrategyEmployingDipstickAnalysisandSelectiveCulture:AnEvaluation TheUtilityofSpotvs24-HourUrineSamplesforMetalDeterminationinVeteransWithRetainedFragments Relatedarticlesin WebofScience GoogleScholar RelatedarticlesinPubMed [Primaryhyperparathyreoidism-diagnosticproceduresandmanagement]. 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