Urinalysis and Urine MCS

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Urinalysis MCS
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• Objective
• What is Urinary Track Infection (UTI)?
• Why Urinalysis MCS is Requested?
• Bacterial Causes of UTI
• Risk Factors For Developing a UTI
• Collection, Transportation and Reception
• Processing Urine analysis and Culture
• Culture media, additional tests and
  identification of common Gram-ve org ve in
  Urine
• Urine parasites
• Recommendation

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• What is Urinary Track Infection (UTI)?
• Any infection of the part of the urinary system
  including kidney, bladder, ureters and the
  urethra.

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• Why it's done
• A urinalysis is a common test that's done for
  several reasons
• To check your overall health. Your doctor may
  recommend a urinalysis as part of a routine
  medical exam, pregnancy checkup, pre-surgery
  preparation, or on hospital admission to screen
  for a variety of disorders, such as diabetes,
  kidney disease and liver disease.
• To diagnose a medical condition. Your doctor may
  suggest a urinalysis if you're experiencing
  abdominal pain, back pain, frequent or painful
  urination, blood in your urine, or other urinary
  problems. A urinalysis may help diagnose the
  cause of these symptoms.
• To monitor a medical condition. If you've been
  diagnosed with a medical condition, such as
  kidney disease or a urinary tract disease, your
  doctor may recommend a urinalysis on a regular
  basis to monitor your condition and treatment. (4)

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Bacterial Causes of UTI Bacteria are by far the
most frequent group of organisms causing urinary
tract infections. Organisms that are known to
commonly cause UTI are E. Coli Staphylococcus
aureus Staph. Saprophyticus Proteus
species Streptococcus faecalis (group D
Strep) Klebsiella species Pseudomonas Spp MTB,
Chlamydia  trachomatis, Mycoplasma, Candida spp
and Leptospira interrogens
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Risk Factors For Developing a UTI 1) UTI is more
common in women than in men because a womens
urethra is located closer to their rectum than
mans. Female urethra is shorter so it is easier
for bacteria to reach the bladder. 2) Pregnant 3)
Post menopausal women with bladder or uterine
prolapse 4) Tumors and kidney or bladder stone
5) Diabetes mellitus 6) Using diaphragm as
contraception 7) Patients with urinary
catheter 8) Enlarge prostate in man 9)
Immunocompromised patients 10) Any medical
condition involving bladder or kidney
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Collection, Transportation and Reception
The urinary catheter Urine specimens for
laboratory investigations can be collected from
catheterized patients as shown (left). The second
port is for putting fluids into the bladder
(right). Urine from the drainage bag should not
be tested because it may have been standing for
several hours.
Type of Specimens

• Midstream urine (MSU)
• Clean catch
• Adhesive bag
• Suprapubic Aspiration
• Catheter sample

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Processing Urine analysis and Culture
Urine analysis 1.Microscopically,
Macro Bacteria, parasite, fungi etc 2.Dip stick
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• Urine analysis
• 1- Microscopy
• 2- Dip stick
• 3- Culture

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Culture media
blood agar
MacConkey agar

CLED agar
a differential medium
an enriched medium
Selective medium
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Laboratory examination of urine
Quantitative (Colony counts)
a urine sample is streaked on surface of Blood
Agar plate and CLED agar / Mc Conkey agar with a
special loop calibrated to deliver a known
volume.
Over night incubation
Isolation of colonies, Biochemical tests, Drug
susceptibility test,
Over night incubation
RESULT
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GRAM NEGATIVE GRAM POSITIVE
Escherichia coli Enterococcus
Klebsiella Staphylococcus saprophyticus
Proteus Streptococcus agalactiae (group B)
Other Enterobacteriaceae (Enterobacter,Citrobacter.) Staphylococcus aureus1 (Associated with staphylococcemia(
Pseudomonas aeruginosa

• Other organisms
• Candida albicans
• Schistosoma haematobium
• Tricomonas vaginalis

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MacConkey's agar showing both lactose and
non-lactose fermenting colonies. Lactose
fermenting colonies are pink whereas non-lactose
fermenting ones are colourless or appear same as
the medium.
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CLED agar
Selective culture medium for detection and
isolation Of Escherichia coli and coliform
bacteria in urine
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MICROSCOPIC APEARANCEGram negative bacilli
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gram negative bacilli
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MacConkeys agar plate showing growth of
Lactose fermenter pink coloniese.g. E. coli

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E coli
Indole Reactions Negative
Positive
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Indol Test
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MacConkeys agar plate showing growth of
Lactose fermenter pink coloniesKlebsiella

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CLED agar plate showing growth of mucoid
coloneis Klebsiella
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MacConkeys plate showing growth of Non -
Lactose fermenter pale coloniese.g. Proteus

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Blood culture palate showing Swarming growth
of Proteus
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Urease Test
proteus is Urease positive Urease splits urea
into ammonia and alkalinizes the urine with
production of crystals
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Proteus growth Swarming
CLED  (Cystine-Lactose-Electrolyte-Deficient) -
inhibits the proteus swarm
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Pseudomonas aeruginosa
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Biochemical Identification
Enterococcus species

• Bile Esculin hydrolysis

Both Group D streptococci and enterococci produce
a positive (left) bile Esculin hydrolysis test.
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MICROSCOPIC APEARANCEGram positive cocci in
clusters most likely staphylococci
FROM CULTURE
SMEAR FROM SPESIMEN Pus cells Gram
positive cocci in clusters
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• To differentiate between Staphylococcus aureus
  Staphylococcus epidermidis use the following
  test
• 1.COAGULASE TEST
• Tube coagulase test
• Slide coagulase test
• 2. DNAase TEST

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1-COAGULASE TEST Slide coagulase
test
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2-DNAase TEST
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Blood agar plate showing growth of
Staphylococcus aureus Colonies are
golden yellow in color
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Staphylococcus spp
Staphylococcus aureus Staphylococcus
epidermidis Golden colonies (yellowish)
white colonies
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CATALASE TEST
Procedure Mix the colony in a drop of hydrogen
peroxide (H2O2)
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COAGULASE TEST Tube coagulase
test
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Differential Characteristics
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NOVOBIOCIN TEST
Staphylococcus saprophyticus (resistant-Novobiocin
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Staphylococcus epidermidis (sensitive-Novobiocin )
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Antibiotic sensitivity test Agar diffusion
method
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Candida albicans

• Growth on Sabouraud's Dextrose Media

• Candida albicans on blood agar

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1.CHLAMYDOSPORE TEST.
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2.GERM TUBE TEST
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Schistosoma haematobium
Schistosoma haematobium(urine eggs 115-170 x
45-65 micrometers)(primates)
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• Recommendation
• CLED Agar
• Hydrogen Perioxide
• Opticin
• Bacitercin
• Nutrient Agar

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Reference 1) Dr S. R. Dutta, PMGH Microbiology
SOP (2011), Port Moresby, NCD. 2) Monica
Cheesbrough, District Laboratory Practice in
Tropical Countries, 2nd Ed, 2006, Cambridge
University Press, Cape Town- South Africa. 3)
David P Kateete, Cyrus N Kimani, Fred A Katabazi
Identification of Staphylococcus aureus DNase
and Mannitol salt agar improve the efficiency of
the tube coagulase test. Am J Clinical
Microbiology and Antimicrobials 2010, 923 4)
http//www.mayoclinic.org/tests-procedures/urinaly
sis
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Presentation By
RABBIE NIGEL BERO Western Highland Provincial
Health Authority, MT HAGEN, Western Highland
Province, Papua New Guinea
THANK YOU