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Quality Manual Version: 2.0 CURRENT
Section: Bacteriology Procedures Subject Title: Urine Culture Manual

TABLE OF CONTENTS

Urinary Tract Infection Workup ................................................................................................................... 3

I. Introduction ......................................................................................................................................... 3
II. Specimen Collection and Transplant .................................................................................................. 4
III. Reagents/Materials/Media .................................................................................................................. 4
IV. Procedure ............................................................................................................................................ 4
Asymptomatic Bacteriuria Urine Hold Processing:................................................................................... 4
List of Uropathogens and Non-Uropathogens:....................................................................................... 5
TABLE 1: Criteria for the identification and susceptibility testing of organisms isolated from Voided
Urines (MSU, neonatal bagged urine, indwelling catheter, Foley catheter urine, ileal conduit urine,
and suprapubic catheter). ........................................................................................................................ 6
TABLE 2: Criteria for identification and susceptibility testing of organisms isolated from In and Out
Catheter/Catheter Insertion urines, Bladder Irrigation urines. ............................................................... 6
TABLE 3: Criteria for the identification and susceptibility testing of organisms isolated from
aseptically collected urine, suprapubic aspirates, cystoscopy urine and nephrostomy urine. ................ 7
V. Reporting............................................................................................................................................. 8
Negative Culture Reporting: .................................................................................................................. 9
Positive Culture Reporting: .................................................................................................................. 11
Growth of Group B streptococci from Female12-60 years: ................................................................. 12
Growth of Group B streptococci from Men/Women not of Childbearing Age <12 or >60 years: ...... 13
VI. References ......................................................................................................................................... 13
Prostatitis Work up ..................................................................................................................................... 14
I. Introduction ....................................................................................................................................... 14
II. Specimen Collection and Transplant ................................................................................................ 14
III. Reagents/Materials/Media ................................................................................................................ 14
IV. Procedure .......................................................................................................................................... 14
a) Cultures with no growth: .............................................................................................................. 15
b) Cultures with growth: ................................................................................................................... 15
TABLE 5: Interpretation Guide for Typical Results of Segmented Urine and EPS Cultures .............. 15
VI. Reporting........................................................................................................................................... 16
Direct Smear (if requested):..................................................................................................................... 16
No growth Report: ................................................................................................................................... 16
Growth with no work-up: ........................................................................................................................ 16
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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Growth with work-up: ............................................................................................................................. 17

VII. References ......................................................................................................................................... 17
Appendix I – Appearance of Common Uropathogens on BUTI (Brilliance) Agar .................................... 18
Gram negative bacteria: ........................................................................................................................... 18
Gram positive bacteria: ............................................................................................................................ 20
Record of Edited Revisions ......................................................................................................................... 22

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Department of Microbiology
Quality Manual Version: 2.0 CURRENT
Section: Bacteriology Procedures Subject Title: Urine Culture Manual
Prepared by QA Committee
Issued by: Laboratory Manager Revision Date: 9/12/2022
Approved by Laboratory Director: Next Review Date: 9/12/2024
Microbiologist-in-Chief
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Urinary Tract Infection Workup

I. Introduction

Urinary tract infections (UTI) are one of the most commonly encountered acute infectious
diseases. Most UTIs occur as a result of bacteria ascending the urethra and entering the
urinary bladder.

Urine specimens for culture are collected when the following syndromes are suspected:
cystitis, pyelonephritis, asymptomatic bacteriuria, and less commonly acute prostatitis,
pyelonephric abscess, and urosepsis.

Among the bacteria most commonly isolated from patients with acute uncomplicated
cystitis are Escherichia coli, Klebsiella species, and other Enterobacterales and
Staphylococcus saprophyticus. Hospitalized patients and patients with complicated
urinary tract infections are commonly infected with E. coli, Klebsiella species, Proteus
mirabilis, other Enterobacterales, Pseudomonas aeruginosa and enterococci.
Corynebacterium urealyticum and Group B Streptococcus are markers of colonization in
pregnant women.

Urine specimens can be divided into categories based on clinical criteria, the possibility
of urethral contamination, and the extent of microbiological work-up.

For diagnosis of Urinary Tract Infection:

- Voided urines (non-sterile): Midstream urine (MSU)
Neonatal bagged urine
Indwelling catheter (Foley catheter) urine
Ileal conduit urine
Suprapubic catheter urine
- In and out catheter / catheter insertion urine / bladder irrigation
- Aseptically collected urine: Nephrostomy urine
cystoscopy urine
Suprapubic aspirate
For diagnosis of Prostatitis:
- Segmented urine and expressed prostatic secretion (EPS). See Prostatitis
Workup
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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

For diagnosis of Male infertility:

- Seminal fluid. See Genital Manual
Quantitative cultures of urine specimens are critical for diagnosis. The criteria to be used
for distinguishing significant from non-significant growth may vary depending on the
type of urine specimen received for culture.

Urine specimens arriving in the laboratory must be accessioned and processed as soon as
possible.

II. Specimen Collection and Transplant

See Pre-analytical Procedure - Specimen Collection QPCMI02001

III. Reagents/Materials/Media

See Analytical Process - Bacteriology Reagents_Materials_Media List QPCMI10001

IV. Procedure

A. Processing of Specimens:

See Specimen Processing Procedure

Asymptomatic Bacteriuria Urine Hold Processing:

See Specimen Processing Procedure for procedure to handle requests to process
Asymptomatic Bacteriuria - Urine “Hold” specimens.

a) Direct Examination:
Gram stain: Not routinely performed. If specifically requested, perform Gram stain
directly on unspun specimen.
Fungal stain: Not routinely performed. If dimorphic fungus or cryptococcus
specifically requested, see Mycology Manual for staining and
interpretation.
Eosinophil stain: Not routinely performed. If requested, stain slide and examine for
the presence of eosinophils due to inter-tissue nephritis.

B. Interpretation of cultures:
Examine plates after appropriate incubation time.
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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

a) Cultures with no growth:

Discard no growth routine cultures after 18-24 hrs incubation.
Exceptions:
- Urine specimens processed after 1600 hrs (plates from the “After 4 p.m.” basket)
– re-incubated until 1400 hrs and re-examine

b) Cultures with growth:

1. If colonies are too small – re-incubate for another 24hrs.
2. Count the colonies and multiply by the appropriate dilution factor in SI units.
Inoculation Loop size Colony count/L
0.001 mL 1 colony = 1 x 106 CFU/L
0.01 mL 1 colony = 0.1 x 106 CFU/L
3. Workup cultures according to the criteria in Tables 1, 2 and 3 below. The
tables are meant to serve as a guide only.
4. Save Group B streptococcus isolates for 10 days at room temperature in case
further susceptibility testing is required
5. Save positive yeast cultures for 10 days at room temperature in case further
work-up is required.

List of Uropathogens and Non-Uropathogens:

Uropathogens Non-uropathogens (normal skin/urogenital flora)
Enterobacterales Lactobacillus
Pseudomonas aeruginosa diphtheroids (not C. urealyticum)
Other gram negative bacilli viridans Streptococci (not A. uriae)
Enterococcus species Streptococcus anginosus group
beta-haemolytic streptococci (Group A, Streptococcus gallolyticus
B, C, G, >0.5mm colonies) Bacillus species
Yeast
Aerococcus urinae*
Aerococcus sanguinicola*
Corynebacterium urealyticum
Staphylococcus aureus
Staphylococcus saprophyticus - (females
12 - 60 yrs only)
Other coagulase negative staphylococci
(including Staphylococcus lugdenensis)*
* Consider as uropathogens only when pure/predominant over non-uropathogens

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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

TABLE 1: Criteria for the identification and susceptibility testing of organisms isolated from
Voided Urines (MSU, neonatal bagged urine, indwelling catheter, Foley catheter urine, ileal
conduit urine, and suprapubic catheter).
No. of Types of No. of colonies of each Colony count/L Work up for Report
1, 2, 3
Organisms type of uropathogens uropathogens
1 <10 <10 x 106 CFU/L No work-up No significant
growth
1 >10 10 x 10 CFU/L
6
ID + Sens 10-100 x E6 cfu/L

2 Both >100 >100 x 106 CFU/L ID + Sens on both >100 x E6 cfu/L

2 One >100 >100 x 106 CFU/L ID + Sens >100 x E6 cfu/L

One <100 <100 x 106 CFU/L Ignore
2 Both <100 <100 x106 CFU/L No work-up No significant
growth
3 All uropathogens <100 No work-up No significant
growth
3 Any uropathogen >100 No work-up Mixed growth
ID =Identification; = Susceptibility testing as appropriate
Note: 1. When counting the types of organisms, do not include <10 colonies of non-uropathogens.
2. Do not workup or report any number of colonies of non-uropathogens
3. For female ages 12-60 yrs, workup any amount of beta-haemolytic streptococcus to rule out Group B
streptococcus. (Reporting – follow Reporting Table for GBS)

TABLE 2: Criteria for identification and susceptibility testing of organisms isolated from In and
Out Catheter/Catheter Insertion urines, Bladder Irrigation urines.
No. of Types of No. of colonies of each Colony count/L Work-up for Report
Organisms 1, 2, 3 type of uropathogens uropathogens
1 <10 <10 x 106 CFU/L No work-up No significant
growth
1 >10 10 x 10 CFU/L
6
ID + Sens 10-100 x E6 cfu/L or
>100 x E6 cfu/L
2 Both >10 10 x 10 CFU/L
6
ID + Sens 10-100 x E6 cfu/L or
>100 x E6 cfu/L
2 One >10 10 x 10 /L
6
ID + Sens 10-100 x E6 cfu/L or
>100 x E6 cfu/L

One <10 or factor of 10x Use phrase - Light Describe4

less growth -on LIS
TEST Comment
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No. of Types of No. of colonies of each Colony count/L Work-up for Report
Organisms 1, 2, 3 type of uropathogens uropathogens
(do not enter as
ISOLATE)
3 >10 >10 x 106 CFU/L ID + Sens 10-100 x E6 cfu/L or
10-100 x E6 cfu/L

Other(s) <10 or factor of Use phrase - Light Describe4

10x less growth -on LIS
TEST Comment
(do not enter as
ISOLATE)
4 All uropathogens <10 No work-up No significant
growth
4 Any uropathogen >10 No work-up Mixed growth

ID = Identification; Sens = Susceptibility testing as appropriate

Note: 1. When counting the types of organisms, do not include <10 colonies of non-
uropathogens.
2. Do not workup or report any number of colonies of non-uropathogens.
3. For female ages 12-60 yrs, workup any amount of beta-haemolytic streptococcus to rule
out Group B streptococcus. (Reporting – follow Reporting Table for GBS)
4. Describe as Gram positive cocci, Gram positive bacilli, Gram negative bacilli.

TABLE 3: Criteria for the identification and susceptibility testing of organisms isolated from
aseptically collected urine, suprapubic aspirates, cystoscopy urine and nephrostomy urine.

No. of Types of No. of colonies of Colony count/ L Work-up

Organisms each type
Any # Any Quantitate using appropriate dilution factor ID & Sens

Inoculation Loop size Colony count/L

0.001 mL 1 colony = 1 x 106 CFU/L
0.01 mL 1 colony = 0.1 x 106 CFU/L
ID = Identification; Sens = Susceptibility testing as appropriate

C. Susceptibility Testing:
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Refer to Susceptibility Testing Manual

V. Reporting

Direct Smear (if requested):

Gram Stain: “(No) Pus cells seen. (No) Bacteria seen” (without quantitation)

Eosinophil Stain: Negative report: “No Eosinophil seen”

Positive report: “Eosinophils present”

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Negative Culture Reporting:

Result Category Reporting

C&S C&S + routine fungus C&S + routine fungus requested and Cryptococcus or
requested and no FUNGUS test ordered specific filamentous
FUNGUS test ordered fungus requested
“No growth” “No growth. Routine urine C&S TEST - “No growth” C&S TEST - “No
No growth fungal cultures screen for growth”
significant growth of yeast Fungus TEST - “No growth. Routine urine Fungus TEST – as per
only. Filamentous fungi fungal cultures screen for significant growth Mycology manual.
will not be ruled out unless of yeast only. Filamentous fungi will not be
a specific request is made” ruled out unless a specific request is made”
(pick from TEST window (pick from TEST window keypad - }NGU)
keypad - }NGU).
“No significant “No significant C&S TEST - “No significant C&S TEST - “No
No significant growth” (pick growth. Routine urine growth. Routine urine fungal cultures screen significant growth”
growth from TEST fungal cultures screen for for significant growth of yeast only. (pick from TEST
window keypad significant growth of yeast Filamentous fungi will not be ruled out window keypad -
 Growth with - }NSG) only. Filamentous fungi unless a specific request is made.” (pick from }NSG)
no workup will not be ruled out unless TEST window keypad - }NSGU)
a specific request is made.” Fungus TEST - “No significant Fungus TEST - as per
(pick from TEST window growth. Routine urine fungal cultures screen Mycology manual.
keypad - }NSGU) for significant growth of yeast only.
Filamentous fungi will not be ruled out
unless a specific request is made.” (pick from
TEST window keypad - }NSGU)
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Result Category Reporting

C&S C&S + routine fungus C&S + routine fungus requested Cryptococcus or
requested and no and FUNGUS test ordered specific filamentous
FUNGUS test ordered fungus requested
“Mixed growth. Suggest “Mixed growth. C&S TEST - “Mixed growth. C&S TEST - “Mixed
Mixed growth repeat specimen if Suggest repeat Suggest repeat specimen if growth. Suggest repeat
patient’s symptoms specimen if patient’s patient’s symptoms suggest a specimen if patient’s
suggest a urinary tract symptoms suggest a urinary tract infection.” symptoms suggest a
infection.” urinary tract infection.” (Pick from LIS TEST window urinary tract
(Pick from LIS TEST (Pick from LIS TEST keypad “Mixed }MIXG”) infection.”
window keypad “Mixed window keypad (Pick from LIS TEST
}MIXG”) “Mixed }MIXG”) window keypad
“Mixed }MIXG”)
Fungus TEST - “Mixed growth. Fungus TEST - as per
Suggest repeat specimen if Mycology manual.
patient’s symptoms suggest a
urinary tract infection.”
(Pick from LIS TEST window
keypad “Mixed }MIXG”)

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Positive Culture Reporting:

Result Category Reporting
C&S C&S + routine fungus C&S + routine fungus requested and Cryptococcus or specific
requested and no FUNGUS test ordered filamentous fungus
FUNGUS test ordered requested
Growth with Morphologic description of organism with corresponding colony count/L - choose from LIS ISOLATE window keypad:
workup \<=10 for <10 x E6 cfu/L,
Preliminary \<100 for 10-100 x E6 cfu/L,
report \>100 for >100 x E6 cfu/L.
Growth with Organism name Organism name with C&S TEST - Organism name with C&S TEST - Organism
workup with corresponding corresponding colony corresponding colony count/L (choose name with corresponding
Final report colony count/ count/L (choose from LIS from LIS ISOLATE window keypad as colony count/L (choose
L (choose from ISOLATE keypad) and above) and susceptibility testing results. from LIS ISOLATE
LIS ISOLATE susceptibility testing Add “No significant yeast isolated. window keypad as above)
window keypad as results. Routine urine fungal cultures screen for and susceptibility testing
above) and Add “No significant significant growth of yeast only. results.
susceptibility yeast isolated. Routine Filamentous fungi will not be ruled out
testing results. urine fungal cultures unless a specific request is made.”(pick
screen for significant from TEST window keypad - }NYSU)
growth of yeast only. Fungus TEST - (pick from TEST Fungus TEST - as per
Filamentous fungi will window keypad - }NYSU) as above Mycology manual.
not be ruled out unless a
specific request is
made.”(pick from TEST
window keypad }NYSU)
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Growth of Group B streptococci from Female12-60 years:

Result Category Reporting
Report as Isolate with corresponding colony count/L. Add ISOLATE Comment “This organism is
Significant amount intrinsically susceptible to penicillin. If treatment is required AND this patient cannot be treated with
penicillin, empiric treatment with nitrofurantoin or levofloxacin is generally successful for bacteriuria. If
advice regarding antimicrobial treatment is desired, please contact the medical microbiologist on-call.
NOTE REGARDING PREGNANT PATIENTS:
Any women with GBS bacteriuria in any concentration during her pregnancy should also receive intrapartum
chemoprophylaxis. Reference: J Obs Gyn Can 2004; 26(9):826-32. If this patient is pregnant AND cannot be
treated with penicillin, please contact the Microbiology Department within 48 hours for susceptibility tests
to help guide intrapartum chemoprophylaxis.” (Pick from LIS ISOLATE window keypad “\GBSU for
female 12-60y”)
Report TEST Comment: “Group B streptococcus isolated but in amounts too small to suggest a GBS urinary
Non-significant amount tract infection. However, any woman with GBS bacteriuria in any concentration during her pregnancy
should receive intrapartum chemoprophylaxis. Reference: J Obs Gyn Can 2004; 26(9):826-32. This
organism is intrinsically susceptible to penicillin. If this patient is pregnant AND cannot be treated with
penicillin, please contact the Microbiology Department within 48 hours to request susceptibility testing.”
(Pick from LIS TEST window keypad “Group B }GBsm”)
“Mixed growth, including Group B streptococcus (GBS). Suggest repeat specimen if patient’s symptoms
Mixed growth with GBS suggest a urinary tract infection. Any women with GBS bacteriuria during her pregnancy, even in mixed
growth, should receive intrapartum chemoprophylaxis. Reference: J Obs Gyn Can 2004; 26(9):826-32. This
organism is intrinsically susceptible to penicillin. If this patient is pregnant AND cannot be treated with
penicillin, please contact the Microbiology Department within 48 hours to request susceptibility testing.”
(Pick from LIS TEST window “Mixed }wGBS”)

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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Growth of Group B streptococci from Men/Women not of Childbearing Age <12 or >60 years:

Result Category Reporting

Report as Isolate with corresponding colony count/L. Add ISOLATE Comment “This
Significant amount organism is intrinsically susceptible to penicillin. If treatment is required AND this patient
cannot be treated with penicillin, empiric treatment with nitrofurantoin or levofloxacin is
generally successful for bacteriuria. If advice regarding antimicrobial treatment is desired,
please contact the medical microbiologist on-call.” (Pick from LIS ISOLATE window
keypad “\GBS” )

VI. References

 Murray P.R., Baron E.J., Pfaller M.A., Yolken R.H.. 2003. Manual of Clinical Microbiology, 8th ed. ASM Press, Washington,
D.C.
 Izenberg H.D.. 2003. Urine Cultures, 3.12.1 in Clinical Microbiology Procedures Handbook, 2nd ed. Vol.1 ASM Press,
Washington, D.C.
 Burd, E.M., Hall, G.S., McCarter, Y.S., Zervos, M. 2009. Cumitech 2C, Laboratory Diagnosis of Urinary Tract Infections,
Coordinating ed., A.S. Weissfield. ASM, Washington, D.C.

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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Prostatitis Work up

I. Introduction

Bacterial cultures of segmented lower urinary tract specimens can be used to differentiate
urethritis/cystitis and prostatitis depending on the different quantitation of growth in the different
segmented specimens.

Segmented quantitation culture specimens include initial stream sample of urine (VB1), a
midstream urine sample (VB2), an aliquot of expressed prostatic secretion (EPS) and a post
prostatic massage secretion (VB3).

When seminal fluid is sent with VB1, 2 or 3, it should be treated as EPS. Occasionally, only a
pre-massage (VB1 or VB2) and post-massage (VB3) urine specimen will be received.

II. Specimen Collection and Transplant

See Pre-analytical Procedure - Specimen Collection QPCMI02001

III. Reagents/Materials/Media

See Analytical Process - Bacteriology Reagents_Materials_Media List QPCMI10001

IV. Procedure

A. Processing of Specimens:

See Specimen Processing Procedure

a) Direct Examination:
Gram stain: Not routinely performed. If specifically requested, perform Gram stain
directly on unspun specimen.
b) Culture:

See Specimen Processing Procedure

B. Interpretation of cultures:
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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Examine plates after appropriate incubation time.

a) Cultures with no growth:

Discard no growth routine cultures after 18-24 hrs incubation. Except:

- Urine specimens processed after 1600 hrs (plates from the “After 4 p.m.” basket) – re-
incubated until 1400 hrs and re-examine
- When yeast or non-specified fungus is requested – re-incubate for another 24 hrs at
room temperature.
- If colonies are too small – re-incubate for another 24hrs.

b) Cultures with growth:

1. For each plate, count the colonies and multiply by the appropriate dilution factor in SI
units.
2. Workup cultures according to the criteria in Tables 4.

TABLE 4: Segmented Urine and Expressed Prostatic Secretion (EPS)

Inoculation Loop size Colony count/L Work-up
Uropathogens:
Quantitate, ID + susceptibility

Non-uropathogens:
0.001 mL 1 colony = 1 x 106 CFU/L
Quantitate, minimal workup
0.01 mL 1 colony = 0.1 x 106 CFU/L
for ID (describe in broad
groups, coag neg staph,
viridans strep, etc).
No susceptibility

Note: Consider coagulase-negative staphylococcus as uropathogens only when present in amounts >10-
fold more that other non-uropathogens.

See Identification and Methods for Common Urinary Tract Isolates for workup.

TABLE 5: Interpretation Guide for Typical Results of Segmented Urine and EPS Cultures
Pre-massage samples Prostatic massage sample Post-massage sample Possible Diagnosis
VB1 VB2 EPS VB3
- - + - Prostatitis
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 Policy # MI_UR
Department of Microbiology Page 16 of 23
Quality Manual Version: 2.0 CURRENT
Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Pre-massage samples Prostatic massage sample Post-massage sample Possible Diagnosis

- - + + Prostatitis
+ + + + Cystitis+Prostatitis
+ + - ++ (10 fold >VB2) Cystitis+Prostatitis
+ + - + Urethritis/Cystitis
+ - - - Contamination
- - - - No infection
+ = growth of the same isolate type in each sample

C. Susceptibility Testing:

Refer to Susceptibility Testing Manual

VI. Reporting

Segmented Urine and Expressed Prostatic Secretion for diagnosis of Prostatitis:

Direct Smear (if requested):

Gram Stain: “(No) Pus cells seen. (No) Bacteria seen” (without quantitation)

Culture:

No growth Report:

“No Growth”

Growth Report:

Growth with no work-up:

Report as TEST Comment “highest colony count - choose
from LIS TEST window keypad:
}<1 for <1 x E6 cfu/L,
}<10 for 1-9 x E6 cfu/L,
}<100 for 10-100 x E6 cfu/L,
}>100 for >100 x E6 cfu/L
and Skin/Urethral Flora”

UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Growth with work-up:

Organism name with corresponding (highest colony count -
choose from LIS ISOLATE window keypad:
\<1 for <1 x E6 cfu/L,
\<10 for 1-9 x E6 cfu/L,
\<100 for 10-100 x E6 cfu/L,
\>100 for >100 x E6 cfu/L)
and appropriate susceptibility testing results.

VII. References

 Murray P.R., Baron E.J., Pfaller M.A., Yolken R.H. 2003. Manual of Clinical Microbiology,
8th ed. ASM Press, Washington, D.C.
 Izenberg H.D. 2003. Urine Cultures, 3.12.1 in Clinical Microbiology Procedures Handbook,
2nd ed. Vol.1 ASM Press, Washington, D.C.
 Burd, E.M., Hall, G.S., McCarter, Y.S., Zervos, M. 2009. Cumitech 2C, Laboratory
Diagnosis of Urinary Tract Infections, Coordinating ed., A.S. Weissfield. ASM,
Washington, D.C.
 Meares E.M. Investigative Urology 1968. 5(5):492-518
 Nickel J.C. Techniques in Urology 1997. 3(10):38-43.

UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Appendix I – Appearance of Common Uropathogens on BUTI (Brilliance) Agar

Gram negative bacteria:

Figure 1: Left – NLF E.coli, Right – LF E.coli

Both display burgundy/pink colonies on BUTI. No growth on CNA.
Visual E.coli identification acceptable. No MS needed. Requires antimicrobial sensitivities if
of significant amount.

UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Figure 2: Left and Right – K. pneumoniae

Klebsiella, Enterobacter, Citrobacter display blue/green colonies on BUTI. No growth on
CNA.
Requires identification and antimicrobial sensitivities if significant amount.

Figure 3: Left – P. aeruginosa, Right – mucoid P. aeruginosa:

Display brown/beige colonies on BUTI. No growth on CNA.
UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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Requires identification and antimicrobial sensitivities if of significant amount.

Gram positive bacteria:

Figure 4: Staphylococcus species

Display colourless colonies on BUTI. Growth on CNA.
Requires identification and antimicrobial sensitivities as required.

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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Figure 5: Enterococcus species

Display blue colonies on BUTI. Growth on CNA.
Requires identification and antimicrobial sensitivities.

Figure 6: Beta-hemolytic streptococcus:

Display violet, blue or colourless colonies on BUTI. Growth on CNA with hemolysis.
Requires identification and antimicrobial sensitivities if requested.
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Record of Edited Revisions

Manual Section Name: Urine Culture Manual

Page Number / Item Date of Revision Signature of

Approval
Annual Review May 26, 2004 Dr. T. Mazzulli
Annual Review May 12, 2005 Dr. T. Mazzulli
Annual Review April 10, 2006 Dr. T. Mazzulli
Specimen collection procedure – see Pre-analytical April 10, 2006 Dr. T. Mazzulli
Procedure - Specimen Collection QPCMI02001
Specimen processing procedure - See Specimen April 10, 2006 Dr. T. Mazzulli
Processing Procedure QPCMI06003
Modify urine category page 2 April 10, 2006 Dr. T. Mazzulli
Removed Specimen Rejection Criteria; refer to Specimen April 10, 2006 Dr. T. Mazzulli
Rejection Criteria QPCMI06001
Modified Interpretation of Culture wording Page 3 April 10, 2006 Dr. T. Mazzulli
C. urealyticum and A. uriae added to the ID table Page 6 April 10, 2006 Dr. T. Mazzulli
New Reporting category and phrases Page 7, 8 April 10, 2006 Dr. T. Mazzulli
New Table of Contents page April 10, 2006 Dr. T. Mazzulli
New section and workup table for segmented urine and April 10, 2006 Dr. T. Mazzulli
EPS
Work-up any amount of beta-haemolytic strep to rule out April 10, 2006 Dr. T. Mazzulli
GBS in females 12-60 years.
Report >3 types of uropathogens as “mixed growth…..” April 10, 2006 Dr. T. Mazzulli
Urine Reporting August 03, 2006 Dr. T. Mazzulli
Prostatitis Workup Reporting August 03, 2006 Dr. T. Mazzulli
Urine interpretation tables 1 and 2 – modified “mixed September 14, 2006 Dr. T. Mazzulli
growth”
Modified Urine “mixed growth” reporting phrase September 14, 2006 Dr. T. Mazzulli
Annual Review August 13, 2007 Dr. T. Mazzulli
Annual Review August 15, 2008 Dr. T. Mazzulli
Annual Review August 10, 2009 Dr. T. Mazzulli
Annual Review June 18, 2010 Dr. T. Mazzulli
GBS reporting phrases June 18, 2010 Dr. T. Mazzulli
Suprapubic/Asceptically collected urine processing to June 18, 2010 Dr. T. Mazzulli
10uL and 100uL loops
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Section: Bacteriology Procedures Subject Title: Urine Culture Manual

Page Number / Item Date of Revision Signature of

Approval
Annual Review June 20, 2011 Dr. T. Mazzulli
Annual Review June 30, 2012 Dr. T. Mazzulli
Annual Review August 25, 2013 Dr. T. Mazzulli
Modify Headers June 11, 2014 Dr. T. Mazzulli
Modify Table of Contents
Annual Review
Add on Streptococcus anginosus group and December 23, 2014 Dr. T. Mazzulli
Streptococcus gallolyticus as non-uropathognes
Addition of Appendix 1 February 1, 2015 Dr. T. Mazzulli
Addition of link Urine Hold to work up April 30, 2015 Dr. T. Mazzulli
Annual Review
Annual Review April 20, 2016 Dr. T. Mazzulli
Update CPS4 to Brilliance BUTI media
Updated UHN/MSH logo in header
Removed Asymptomatic Bacteriuria - Urine hold study January 31, 2017 Dr. T. Mazzulli
link. Study transferred to routine specimen processing
manual. Replaced link with one to specimen processing
manual.
Annual Review April 20, 2017 Dr. T. Mazzulli
Annual Review April 15, 2018 Dr. T. Mazzulli
Annual Review September 14, 2019 Dr. T. Mazzulli
Minor format change
Annual review September 25, 2020 Dr. T. Mazzulli
Full document review included in all updates. Bi-annual review conducted when no revision had been
made within 2 years.
Page Number / Item Date of Revision Edited by:
Removed reincubate additional 24hr for suprapubic/yeast January 21, 2021 Dorna Zareianjahromi
fungus request. Specified beta-hem strep in list of
uropathogens
Minor formatting change April 11, 2021 Jessica Bourke
Nomenclature update – Enterobacterales April 19, 2021 Wayne Chiu
Added Aerococcus sanguinicola as possible uropath May 19, 2022 Wayne Chiu
Added bladder irrigation sample to table 2 workup Sep 2, 2022 Wayne Chiu

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