Rapid Screening of Urinary Tract Infection and Discrimination of Gram-Positive and Gram-Negative Bacteria by Automated Flow Cytometric Analysis Using Sysmex UF-5000

Rapid screening of urinary tract infection is important to determine antibiotic treatment and reduce unnecessary urine culture. We evaluated the performance of the new flow cytometry-based UF-5000 automated urine analyzer (Sysmex, Kobe, Japan). A total of 1,430 urine samples from 1,226 patients were analyzed and compared to urine cultures to which a Previ Isola (bioMerieux, Marcy l'Etoile, France) system was applied. In total, 878 of 1,430 urine cultures (61.4%) produced >= 10(3) CFU/ml bacterial growth (309 with Gram-negative [GN] bacteria, 517 with Gram-positive [GP] bacteria, and 52 mixed cultures), with 336 samples (23.5%) presenting >= 10(5) CFU/ml bacterial growth. The >= 10(5) CFU/ml bacterial growth was detected by a >= 71 bacteria/mu l UF-5000 bacterial count with 95% sensitivity and 84% specificity. Using a cutoff of <15 bacteria/mu l to determine whether or not to culture, 50.9% of samples were below the cutoff, 94.8 and 99.5% of which presented <10(4) and <10(5) CFU/ml of bacterial growth, respectively. The bacterial discrimination performance of the UF-5000 for GN bacteria was superior to that for GP bacteria, and in >= 10(5) CFU/ml monobacterial samples, the sensitivity and specificity for reporting GN bacteria were 91.7 and 90.0%, respectively. In summary, UF-5000 demonstrated potential utility for the rapid screening of negative bacterial cultures. However, this utility is dependent on the patient population; cutoff optimizations must be performed for specific populations. In addition, UF-5000 presented improved performance in characterizing GP and GN bacteria, although the concurrence rates were not high enough to replace routine cultures.