From the Guidelines
Yes, a repeat urine culture is indicated for persistent urinary tract infection (UTI) symptoms.
Indications for Repeat Urine Culture
- Persistent UTI symptoms despite antimicrobial therapy 1
- Symptoms that do not resolve or recur within 4 weeks after completion of treatment 1
- Women who present with atypical symptoms 1
- Pregnant women 1
- Suspected acute pyelonephritis 1
Rationale for Repeat Urine Culture
A repeat urine culture is necessary to guide further management and assess for ongoing bacteriuria before prescribing additional antibiotics 1. This approach helps minimize unnecessary treatment of patients with persistent UTI/pain symptoms who are culture-negative 1.
Key Considerations
- Use prior culture data to choose among first-line treatments while culture is pending 1
- Consider antibiotic resistance patterns in the patient and the community (local antibiograms) as well as patient allergies, side effects, and cost 1
- Avoid treatment of asymptomatic bacteriuria in women with recurrent UTI, as this has been shown to foster antimicrobial resistance and increase the number of recurrent UTI episodes 1
From the Research
Indications for Repeat Urine Culture
- A repeat urine culture may be indicated for persistent urinary tract infection (UTI) symptoms, as it can help identify significant bacteriuria and provide an accurate microbiological report with antibiotic sensitivity pattern 2.
- The decision to perform a repeat urine culture should be based on clinical correlation and the presence of symptoms, rather than solely on the results of the initial culture 3.
Utility of Repeat Urine Culture
- Repeat urine cultures can help identify asymptomatic bacteriuria, complicated UTI, and uncomplicated UTI, and can inform treatment decisions 2.
- The use of advanced testing, such as PCR UTI testing, may also be useful in the diagnosis and management of recurrent and complicated UTIs 4.
- Diagnostic stewardship for UTI, including the use of urine culture, is important for reducing unnecessary antibiotic use and misdiagnosis of UTI 5.
Comparison of Urine Culture Methods
- Different urine culture methods, such as the conventional 1-µL culture method, the modified 100-µL culture method, and the centrifugal urine sediment culture method, may have varying detection rates of pathogenic bacteria in patients with UTIs 6.
- The choice of urine culture method may depend on the clinical context and the presence of symptoms, and should be guided by expert guidance and clinical correlation 5.