Culture of the urine

The nature and number of organisms present in the urine are the most useful indicators of UTI. 1

• Most common are enteric organisms. Escherichia coli is responsible for about 90% of UTIs with other Gram-negative organisms (Klebsiella sp and Proteus sp) and Gram-positive cocci (Streptococcus faecalis and staphylococci) also occurring.

• Infections due to organisms other than E.coli, e.g. Pseudomonas sp, are suggestive of an underlying renal tract abnormality.

• If > 10 5 colony forming units (cfu) per mL of bacteria are present in an MSU, it is highly likely that the patient has a UTI.

• On the other hand, it is most important to realise that up to 30% of women with acute bacterial cystitis have less than 10 5 cfu/mL in the MSU. For this reason, it is reasonable to treat women with dysuria and frequency even if they have <10 5 cfu/mL of organisms in an MSU.

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