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Thread: help lab says my urine is ?contaminated?

  1. #1
    Senior Member
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    Jun 2004
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    Indpls, IN USA
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    help lab says my urine is ?contaminated?

    We took a sample from my SP to the hospital lab we always use. My husband (as always) wore gloves, cleaned the sample port w/alcohol, used a new needle/syringe and put it in a sterile collection cup. We also put a label on it explaining my situation and explained it also to the person at the lab (that it would have more bacteria due to the indwelling catheter).

    Well?the lab said the sample was positive but contaminated and mentioned something about skin cells. Do I have to go through this again? (I was put on a broad spectrum antibiotic-Macrobid-and told if it didn?t go away to come in and have a ?clean? sample drawn).
    "courage is fear that has said its prayers"

  2. #2
    Senior Member
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    Sep 2001
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    middle georgia
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    I was told that the cathe if full of germ you need a clean cath and that fresh urine that comes out will not be containated

  3. #3
    Who prescribed Macrobid? Antibiotics should not be taken unless a culture and sensitivity urine test (C&S) indicates a particular bacteria and which antibiotics are most effective in treating the infection. You will need to be off Macrobid for two to three days before another specimen can be submitted.

    It is also good to remember that urine specimens can be contaminated at the lab. It happens.

  4. #4
    It is unfortunately common to have labs reject urine specimens in which there are more than 2 types of bacteria present on microscopic exam. This is because in ABs, even with a clean catch urine and a real UTI, rarely have more than 1 type of bacteria present. This is not the case in people with SCI. Your provider should instruct the lab to run your specimens regardless of the number of bacteria present if you are collecting the specimens properly as you describe. They may need to speak to the pathologist in charge of the lab so this can be set up for you automatically whenever you submit a specimen.

    I am concerned about you being placed on an antibiotic (the Macrobid) unless you have actual symptoms of a UTI (fever, chills, elevated WBC in your blood, flank pain, bad AD, severe leakage around your catheter, or malaise. You should not be treated just positive cultures (colonization).

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #5
    Quote Originally Posted by SCI-Nurse View Post
    It is unfortunately common to have labs reject urine specimens in which there are more than 2 types of bacteria present on microscopic exam. This is because in ABs, even with a clean catch urine and a real UTI, rarely have more than 1 type of bacteria present. This is not the case in people with SCI. Your provider should instruct the lab to run your specimens regardless of the number of bacteria present if you are collecting the specimens properly as you describe. They may need to speak to the pathologist in charge of the lab so this can be set up for you automatically whenever you submit a specimen.

    (KLD)

    This is good advice.

    We have had this problem multiple times. The sample was collected with a catheterization ... which is about as clean as you can get. If it grows out 2 or more bacteria, the lab will automatically "decide" it must not be a real infection and is likely contaminated from skin bugs so they don't do the full analysis. Or sometimes my Dad clearly had a symptomatic UTI and only 10-20,000 bacteria grew out (instead of > 100,000), but again... the lab doesn't realize that this is still a UTI for some of us with SCI..... so they don't finish the analysis/sensitivities, because the lab "decided" it wasn't a real infection.

    Even though my Dad's doctor now writes on the prescription "always do sensitivities", the lab often screws up.

    But you can call the lab (or the doctor can in the morning) as they still have the sample and tell the lab to complete the analysis and do the sensitivities on all the organisms. They keep the samples for several days, so if you contact them soon you can still get the information you need. If you try to collect another sample now, after having already started the antibiotics, it wont likely grow well. So tell them to work on that first sample.

  6. #6
    As a general rule (here anyway) is no antibiotics before a C&S is sent in. As other have said, it's odd that that they put you on Macrobid right away. Well ok, not that odd, many that aren't familiar with catheters don't always factor in that most of us are colonized and that having bacteria doesn't automatically mean an infection. Best bet is probably to submit another sample, just in case. And make sure you mention on the lab sheet that you're currently taking Macrobid because that will affect the culture. I rarely start antibiotics unless I'm pretty bad off and we decide that waiting 48hrs for the results is risky. And if I do, I have a stack of C&S requests in the glove box of my car so that I can drop off a sample ASAP and then start antibiotics after. Because if the Macrobid kills whatever bug is causing an infection enough for it not to show up on the C&S well and it returns, OR if things get worse and you get sepsis, docs will have no idea what bug to treat (in that case, time isn't really on your side so always better to know what bug you're dealing with).

    This has happened to me multiple times, only my lab determines that 3+ organisms = contaminated. My lab also has a check box that you can mark if you have an indwelling and the method by which you're collecting it. Might be worth writing it in the comment section if there's no checkboxes on your test sheet (or asking lab staff). They also add the directive "if clinically indicated, request another sample". So basically if it comes back contaminated but you still have fever/pain/smelly cloudy urine/worse spasms (or whatever your telltale signs are) then do another test. That's what my doc and I go by anyway. A few times the lab itself requested another sample because the container had leaked in transit or the lab tech fudged it. Never know, human error happens. I've also had 2 culture and sensitivity tests in a row turn up contaminated, and I KNEW I had an infection and every sign of it. PCP decided I was colonized. Got sicker and my urologist did a 3rd test - I clearly had 2 bugs and an active infection. Things can go both ways and tests have their limitations, listen to the signs your body is giving off and make sure you get the proper tests in (ideally before antibiotics)! And repeat them if there's reason to do so. I've also had nurses take and send 2 separate samples just to be on the safe side. Sometimes one comes back contaminated and the other doesn't.

    I don't know what kind of set up you have, but I found that the best way to get a clean sample *on my own* or when in a room that's questionably clean (ie. hospital or lab bathroom or crowded ER) is to connect a new leg bag to the catheter (using alcohol wipes etc) and then taking the sample from the brand new bag (NEVER take the sample from a used bag! When I mean a new bag, I mean brand-new, sterile, still in package and put it on seconds before you take the sample). This method is the one that's given me less "contaminated" results. I mean, I'm not dumb (and I used to work in a lab) but it's tricky to get a sample sometimes. I found that messing around with syringes just leaves more room for error, or worse without syringe, I end up losing grip of the tube and touching something or getting it everywhere, or dropping the lid of the container as I'm trying to juggle everything and not spill ha :s. But that's just me...and I now ask for 2 containers in case I drop the first one!
    Last edited by twistties; 10-23-2017 at 12:16 AM.

  7. #7
    My urologist's instruction for getting a urine sample from a supra pubic catheter are:
    Drink a full glass of water.
    Wipe the funnel end of the catheter with alcohol swabs.
    Wipe a catheter plug with alcohol swabs. (Alternatively clamp the catheter tubing closed)
    Insert the catheter plug into the funnel end of the catheter.
    Wait 5-10 minutes.
    Lying on one side, remove the catheter plug and drain urine into a sterile catheter cup. Be careful not to touch the sterile container with the catheter.
    Label and refrigerate.
    Take the specimen to the lab as soon as possible. The specimen should be on ice while transporting it to the lab.

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