Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Urinalysis and Urine Culture

When to Order Urinalysis

Signs and symptoms of urinary tract infection

Patients who cannot provide history and have sepsis with no other plausible source

Urinalysis is NOT recommended based on:

  • Change in urine color, odor, or turbidity (changes are usually due to hydration status rather than infection)

  • Lack of UTI symptoms

  • Automatically in any patient with fever or sepsis workup

  • Pre-operatively except in urologic surgery

  • When a urinary catheter is placed or changed

  • At all admissions

  • After treatment of a UTI to document cure

How to Collect

Catheterized patients

  • In patients with long-term catheters (≥ 2 weeks), replace the catheter before collecting a specimen

  • In patients with short-term catheters, urine samples should be drawn from the catheter port using aseptic technique

  • Should NOT be drawn from the urine collection bag

  • Catheterized patients should NOT be routinely screened

Non-catheterized patients

  • Urethral area should be cleaned with an antiseptic cloth

  • Collect sample midstream or by fresh catheterization

  • Should NOT be taken from a drainage bag or a collection hat

When to Order Urine Culture From Urinalysis

≥100,000 colonies

1000 colonies may indicate infection in patients who are already on antibiotics at the time of culture, patients with a catheter, symptomatic young women, patients with suprapubic aspiration, and men with pyuria

Indicates Contamination

High numbers of epithelial cells on the urinalysis (>20) is highly suggestive of contamination and the culture results should usually be ignored

Positive cultures from a urinalysis negative for pyuria (WBC >10) likely indicate contamination