Antibiotic susceptibility testing, urine

TEST DESCRIPTION

Determination of the sensitivity or resistance of bacteria found in urine to antibiotics by Kirby-Bauer disk diffusion. The pathogenic bacterium is grown on Mueller-Hinton agar in the presence of various antibiotic-impregnated filter paper disks. The extent of growth around the disks is an indirect measure of the ability of that antibiotic to inhibit that bacterium.

Methodology

Disk diffusion

Reference range

Susceptible                                                                                        

TEST FREQUENCY & RESULT AVAILABILITY

Performed daily. Results are typically available within 2 to 3 days.

ACCEPTABLE SPECIMEN TYPES AND COLLECTION

• Preferred: Urine in a container with Boritex preservative.
• Urine in a sterile container. 
• Detailed collection instructions appear below

SPECIMEN STORAGE

Urine in a container with Boritex preservative: Store at room temperature (15–25°C/59–77°F) for up to 72 hours.

Urine in a sterile container: Store at room temperature (15–25°C/59–77°F) for up to 2 hours or refrigerated (2–8 °C/36–46 °F) for up to 24 hours.

SPECIMEN TRANSPORT

Shipping conditions should follow the temperature and time requirements outlined above.

REJECTION CRITERIA

• Holding time greater than 24 hours for refrigerated, unpreserved specimens
• Holding time greater than 72 hours for preserved specimens at room temperature
• Specimens requiring anaerobic culture
• Specimen container not labeled 
• Specimen container has leaked or is not sealed properly 

CODES

CPT: 87184

LOINC: 50546-1

Test code: 2600

TEST FEE

Refer to the current fee schedule.

DETAILED SPECIMEN COLLECTION INSTRUCTIONS

 Provider Instructions Boritex Urine Culture Cup 

1. Label the Boritex Cup with the patient’s information.
2. Have patient submit a clean-catch midstream urine sample in the Boritex Urine Cup.
3. Leave the white tablet in the cup. DO NOT INGEST. DO NOT TOUCH. 
4. Place the Boritex Urine Culture Cup inside the biohazard specimen bag and seal tightly.  
5. Fill out the requisition form completely. Fold it in half once (no staples please) and place in the outer pocket of the biohazard specimen bag (not inside the zippered pouch with the specimen). 
6. Transport to the laboratory within 72 hours of collection. 

Note: the Boritex Urine Culture Cup is the preferred specimen container and can be transported at room temperature within 72 hours. If the urine sample is submitted directly in a sterile container, it must be transported refrigerated and ASAP, but within 24 hours.

 Patient Instructions

Note: It is important that these instructions are followed closely to prevent the urine sample from being contaminated with normal skin bacteria, which may result in the sample being rejected.

1. Ensure the Urine Collection Cup is labeled with your name and date of birth.
2. Wash your hands thoroughly with warm soapy water and dry well.
3. Spread a clean paper towel on a counter or surface you can reach from the toilet.
4. Open the towelette packets and place them on the towel.
5. Take the lid off the Urine Collection Cup. Put the lid (inside facing down) on the paper towel next to the towelettes. Do not touch the inside of the cup or lid.
6. Leave the white tablet in the cup. DO NOT INGEST. DO NOT TOUCH.
7. Cleanse the skin as follows:

Male Patients

1. Wash your entire penis with the first wipe. Throw the towelette away.
2. Pull back on the fold of skin around the tip of your penis (if present) and use the second towelette to cleanse the head of the penis from the center out. Throw the towelette away. 
3. Use the third towelette to cleanse the head of the penis from the center out; throw away.

Female Patients

1. Sit on the toilet and spread your legs apart. Use two fingers on one hand to spread open your labia (the folds of skin on each side of your vagina). Continue holding the labia open until you get the urine sample. The goal is to collect the urine directly into the container without coming in contact with surrounding skin.
2. With your other hand, use the first towelette to wipe the left side of the inner labial folds from front to back in one stroke. Throw the towelette away.
3. Use the second towelette to wipe the right side of the inner labial folds from front to back in one stroke. Throw the towelette away.
4. Use the third towelette to clean in the middle over the opening to your urethra. This is where your urine comes out, and it is just above the opening to your vagina. Throw the towelette away.

1. Urinate the first part of the stream into the toilet and then stop the flow.
2. Hold the urine collection cup a few inches from your urethra. 
3. Urinate into the cup until it is about half full and then stop the flow.
4. Finish urinating in the toilet.
5. Securely screw the lid onto the container, taking care not to touch the inside of the cup or lid. Rinse and dry the outside of the container.
6. Wash hands thoroughly with warm soapy water and dry.