Sensitivity of Extended Cultures in Diagnosing Urinary Tract Infections
Sensitivity of Extended Cultures in Diagnosing Urinary Tract Infections
There is some evidence to suggest standard urine cultures may not be adequate in identifying
 patients with low grade urinary tract infections. Therefore, there are patients with symptoms
 of frequency and urgency, being misdiagnosed with overactive bladder due to negative urine
 cultures. If this is true, could extended cultures be used to identify the false negative
 patients?
In 2014, Hilt, Evann et al published a study called "Urine is not sterile," in which it was
 found via PCR and extended urine cultures, there is a microbiome that exists within the
 urinary bladder. In this study, 92% of the bacteria failed to be identified by a standard
 urine culture but 80% were identified with extended urine cultures. In further explorations
 of the significance of this microbiome, Pearce, Meghan et al. found that the female bladder
 consists of increased abundance of bacteria in patients with UUI; including Gardnerella and
 Lactobacilus gasseri. Then in 2015, a study by Thomas-White, Krystal et al. found that
 patients with urge urinary incontinence (UUI) who responded to treatment with Solifenacin had
 fewer and less diverse communities of bacteria when evaluated by PCR and extended urine
 cultures.

 The clinical significance of the bacteria identified is not well understood. However, these
 studies show that the presence of bacteria is being missed by standard cultures. Dune et al.
 found that of patients with UTI symptoms, 27.5% were standard culture negative but extended
 quantitative urine culture positive. This demonstrates that practitioners may be overlooking
 urinary tract infections in patients with frequency and urgency. Therefore, if bacteria
 within the urine can be detected with extended cultures, can this technique be used to
 improve detection and treatment of urinary infections in patients with symptoms of frequency
 and urgency?

 The hypotheses states that extended urine cultures are more sensitive in the identification
 of urinary tract infections in patients with symptoms of urgency and frequency. The secondary
 hypothesis is that treatment of the uropathogen identified on extended urine cultures will
 improve patient symptoms.
Inclusion Criteria:

 -  18 y/o-70 y/o

 -  Able to consent

 -  Urgency /Frequency

 -  Urge incontinence

 -  PUF score ≤ 4

 -  Bother questionnaire #2 or #3 answered either "a moderate amount" or "a lot"

 Exclusion Criteria:

 -  Pregnant

 -  Pelvic radiation

 -  Chronic pelvic pain

 -  Urinary retention

 -  Greater than Stage 2 prolapse

 -  Renal calculi

 -  Recurrent UTI (2 in 6 months)

 -  Immunosuppressed

 -  Neurologic disorder

 -  No antibiotics in the past 4 weeks