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Robert H. Latham, MD; Edward S. Wong, MD; Ann Larson, MS; Marie Coyle, PhD; Walter E. Stamm, MD

JAMA. 1985;254(23):3333-3336.

Abstract
We evaluated the accuracy and work load of six different approaches to identifying urinary tract infections in a general microbiology laboratory. Midstream urine (MSU) specimens from 387 ambulatory women were examined for pyuria and were cultured using a dual-plating technique that detects both low (10² to 10⁴ organisms per milliliter) and high ( 10⁵ organisms per milliliter) colony counts. Seventy-four urinary tract infections (defined as 10⁵ organisms per milliliter of MSU or 10² aerobic gramnegative bacilli per milliliter of MSU in symptomatic patients) were identified. Twenty-four (32%) of the infections were characterized by low colony counts and would not have been identified using a 10⁵ or greater colony-forming units/mL criterion for infection. Using the presence of pyuria to direct microbiological processing of urine specimens was the most accurate and efficient method of identifying urinary tract infections among voided specimens from ambulatory women, particularly if rapid screening methods for pyuria can be used.

(JAMA 1985;254:3333-3336)

Author Affiliations
From the Departments of Medicine (Drs Latham, Wong, and Stamm) and Microbiology (Ms Larson and Dr Coyle), Harborview Medical Center and the University of Washington, Seattle. Dr Latham is now with the University of Utah School of Medicine, Salt Lake City. Dr Wong is now with the McGuire Veterans Administration Medical Center and the Medical College of Virginia, Richmond.

Footnotes
Reprint requests to the Department of Medicine, Harborview Medical Center ZA-89, 325 Ninth Ave, Seattle, WA 98104 (Dr Stamm).

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