Outpatient urine culture -: Does collection technique matter?

Background: Dysuria is one of the most common presenting complaints of young women, and urinalysis is one of the most common laboratory tests performed. Despite the fact that the midstream clean-catch technique is commonly used for urine collection, contaminated urine cultures occur with distressing regularity. The midstream clean-catch technique is time-consuming to explain, frequently not performed correctly by patients, costly for supplies, often embarrassing for patients and staff, and of unproven benefit. Therefore, we designed a study to compare various methods of obtaining specimens for culture from acutely dysuric young women. Methods: A to tal of 242 consecutive female patients who presented with symptoms suggestive of a urinary tract infection were randomized into 3 groups. The first group (n=77) was instructed to urinate into a clean container. No cleansing was done, and the specimen was not obtained midstream. The second group (n=84) was instructed to collect a midstream urine sample with perineal cleansing and spreading of the labia. In an attempt to decrease contamination from the vagina, the third group (n=81) was given the same instructions as group 2, with the addition of using a vaginal tampon. Contamination rates were calculated for all 3 groups. Results: Contamination rates for the 3 groups were nearly identical (29%, 32%, and 31%, respectively). Comparing the no-cleansing group with the combined cleansing, midstream groups also showed no difference in contamination rates (28.6% and 31.5%, respectively, with P=.65). Conclusions: In young, outpatient women with symptoms suggestive of a urinary tract infection, the midstream clean-catch technique does not decrease contamination rates.