Urine continues to be most important specimen sent for culturing, we teach the under graduate students majority of the

specimens we receive are urine, and most common isolate is E.coli and women suffer the UTI in greater proportions than men. With following of our statistics we find men and women > 60 years of age are becoming greater victims of Urinary tract infections, and with greater difficulties in interpretation with poor clinical information from the Doctors. My observations many nurses consider urine is something carries lesser importance than blood for culturing in septicaemia cases. Most laboratories and Unit chiefs leave the collection of urine for cultures to ill experienced and very junior staff as Urine is least important specimens in the minds of majority of the health care workers. Never forget today the people live longer with multiple complication and constantly put on Medication. I wish if the Microbiologists take some interest in explaining the importance of Urine collection to the senior staff in educating the patients on collection. The first question in urine collection is when we collect the urine 1 A Random sample, many out patients opt for giving a random sample that is anytime sample, this is the specimen most commonly sent to the laboratory for analysis, primarily because it is the easiest to obtain and is readily available. Random specimens can sometimes give an inaccurate results view of a patient's health if the specimen is too diluted and analyse values are artificially lowered. As the name implies, the random specimen can be collected at any time. Although there are no specific guidelines for how the collection should be conducted, avoiding the introduction of contaminants into the specimen is recommended. It is not possible to apply any standard criteria in bacterial counts, and significant bacteria rarely applies to these patient when the specimens are collected without much care, we just start to process major pathogens, as neither the clinician nor microbiologist worried about the results. When we are students lot of importance was given to few investigation we were doing and meticulous attention was paid in collecting and culturing of the urine specimen, today many practitioners write the urine in routine fashion in particular many pregnant women. 2 Early morning sample for culturing if one is serious to establish and diagnose a UTI should switch to early morning samples. This is the specimen of choice for culturing and microscopic analysis, since the more quantity of urine is passed reducing the effects of processing of concentrated urine. Also called an 8-hour specimen, the first morning specimen is collected when the patient first wakes up in the morning, having emptied the bladder before going to sleep. Midstream Clean Catch Specimen this is the preferred type of specimen for culturing and sensitivity testing because of the reduced incidence of cellular and microbial contamination. Patients are required to first cleanse the urethral area with an ordinary soap, can dry the area with towelette just simple tissue paper. The patient should then void the first portion (fore stream) of the urine stream into the toilet. These first steps significantly reduce the opportunities for contaminants to enter into the urine stream. The urine midstream is then collected into a clean container tell the patient not more than half of the container is needed or else it will spill and contaminate the surrounding with urine smell (any excess urine should be voided into the toilet). This method of collection can be conducted at any time of day or night. 3 Catheter Collection of urine Specimen - This assisted procedure is conducted when a patient is bedridden or cannot urinate independently. The healthcare provider inserts a foley catheter into the

bladder through the urethra to collect the urine specimen. Specimens may also be collected through an existing foley catheter with aseptic precautions.) Specimens may be collected directly from a foley into an evacuated tube or transferred from a syringe into a tube or containers. 4 Paediatric Specimen For infants and small children, a special urine collection bag is adhered to the skin surrounding the urethral area. Once the collection is completed, the urine is poured into a collection container. Urine collected from a diaper is not recommended for laboratory testing since contamination from the diaper material may affect test results. If you are getting isolates of Pseudomonas please try your wisdom not to report as pathogen it will be misinterpreted by the Paediatricians, and little children are subjected to toxic antibiotics Please explain the Broomhall method as one of the ideal method ( Refer 13th Edition of Mackie on Diagnostic Microbiology approaches) If you wish to improve the quality of the services from diagnostic Microbiology on reporting of urine for bacteriological evaluation a minimal clinical history is highly sought after which include, 1 Whether the urine is collected before or after the Antibiotic use, so even the lesser counts are significant for consideration, when we put on broad spectrum antibiotics or Cephalosporins as the counts will be reduced in established and persistent infection under the bacteriostatic effect of the even narrow spectrum antibiotics , 2 Should write whether the urine is collected from catheter and also should indicate in postoperative cases, with probable days the catheter is put on without change, as most often we get Candida or Pseudomonas as Major isolates which will disappear after the Catheter is removed, 3 What are the Antibiotics is patient is on 4 and ask them never forget to write when was the last culturing of urine was done what was the report and what are the antibiotics prescribed, so we can have understanding on mistreated chronic Urinary tract Infection Note With rapid Privatization of Diagnostic laboratories many ill experienced Microbiologists and Technicians, many times insignificant growth of bacteria and commensals are processed and Anti biograms are reported which continues to the major reason of the misuse of Antibiotics in major outpatient settings. Dr.T.V.Rao MD Professor of Microbiology Freelance writer,