When should a urine specimen be recollected?

When to Recollect Urine Specimens

Urine specimens should be recollected when they are not properly collected, stored, or transported, as these factors significantly impact diagnostic accuracy and can lead to false results or contamination.

Indications for Recollection

Improper Collection Technique

• A "positive" culture result from a specimen collected in a urine bag cannot be used to document a UTI; confirmation requires culture of a specimen collected through catheterization or suprapubic aspiration (SPA) 1
• For pediatric patients, bag specimens showing positive results require recollection via catheterization or SPA for confirmation 1
• Specimens collected using improper technique (inadequate cleansing, incorrect midstream collection) may need recollection 1

Improper Storage or Transport

• Urine specimens should be recollected if they have been held at room temperature for more than 1 hour without processing 1
• Specimens not refrigerated or preserved with boric acid when transport is delayed beyond 1 hour should be recollected 1
• Urine must be fresh (within 1 hour after voiding with maintenance at room temperature or 4 hours after voiding with refrigeration) to ensure sensitivity and specificity of urinalysis 1

Contamination

• High levels of epithelial cells (>few) suggest contamination and may require recollection 2
• Mixed bacterial flora or growth of multiple organisms (>2 species) indicates contamination and necessitates recollection 1
• For women, contamination rates are high (43.9%) with sterile urine bags, suggesting the need for alternative collection methods 3

Diagnostic Uncertainty

• When initial urinalysis suggests infection but culture results are inconclusive or inconsistent with clinical presentation 1
• When pyuria is present without bacteriuria or vice versa in symptomatic patients 1

Collection Methods to Reduce Need for Recollection

For Adults

• For women, midstream collection with cleansing is recommended to minimize contamination 1
• For men, midstream collection with cleansing is recommended; first-void urine collection is not recommended due to higher contamination rates 1
• A single catheterized urine specimen with one bacterial species yielding ≥10² CFU/mL is sufficient for diagnosis in adults 1

For Children

• For infants and children, catheterization or SPA is preferred over bag collection when UTI is suspected 1
• Bag specimens have significantly higher contamination rates (43.9%) compared to clean catch (14.3%), catheterization (14.3%), or SPA (9.1%) 3

Proper Specimen Handling

• If transport will be delayed >1 hour, refrigerate the specimen 1
• Alternatively, use a urine preservative device containing boric acid for transport to remote laboratories 1
• Specimens must be transported to the laboratory in a timely fashion to limit bacterial growth 1

Common Pitfalls to Avoid

• Collecting urine from drainage bags rather than directly from the catheter port 1
• Failure to properly cleanse the perineum before collection, especially in children 1
• Relying solely on urinalysis without culture for diagnosis of UTI 1
• Assuming that posted instructions alone will improve collection technique (studies show this is ineffective) 4
• Interpreting abnormal urinalysis results as definitive for UTI without considering collection technique issues 2

Remember that proper collection technique is essential for accurate diagnosis, and contaminated specimens lead to unnecessary repeat testing, increased costs, and potential diagnostic errors 3.