Dr. Shubadeep Debabrata Sinha
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I take care of my 95-year-old mother. Can one have a complete negative urinalysis for WBCs, nitrites, and RBCs but still have a positive urine culture? If a doctor does not request urine microscopy and you do not take it midstream or a senior citizen cannot do it easily, will it not create a false positive that you are culturing not what is in the bladder but in the vagina. And secondly, if there is no contamination outside in the first place, do you not need leukocytes to demonstrate an actual infection? Or the bacteria which is grown is asymptomatic.
In my mother's case, she had E.coli bladder symptoms with urinary issues with both positive cultures and urinalysis. She has not had a bladder infection for five years. But now she has had increased confusion and incontinence and has advanced dementia. I do not know at this point if the urine culture is positive. Results are pending. Even if positive, I do not wish to treat it as it will set her up for reoccurring UTIs, which happened in the past. Also, her electrolyte levels are normal. What to do?
Please help.
Hi,
Welcome to icliniq.com.
I understand your query.
Yes, there are chances to have a positive urine culture despite normal WBC (white blood cell) levels, urine routine, and microscopy reports, which are, at best, screening tools. However, it may also be the opposite, that is, leukocytes and pus cells will be present in urine, but urine culture will be negative. And you are not incorrect about midstream urine collection. If incorrectly taken, it could lead to the detection of bacteria from the reproductive tract. However, urinary bacteria have different types though E.coli (Escherichia coli) is the most common bacteria from urinary, vaginal, and fecal routes.
Hence if E.coli is detected, it is better to treat it with appropriate antibiotics for about 10 to 14 days, which will take care of bacteria from any source. The same applies to other bacteria of the urinary tract. Treating UTIs (urinary tract infections) early has been shown to benefit by preventing possible urinary complications. Please share the urine culture reports when you get them. Until then, please continue the instructions as suggested.
I hope this was helpful.
Kindly follow up with the reports.
Patient's Query
Hi doctor,
Thank you for your reply.
The result came back with mixed growth of doubtful significance. So it is probably not a clean sample. But my point is if it had been a high E.coli count and WBCs were negative, can you have this type of situation where it would still cause confusion in a senior citizen?
If electrolytes are all normal. How does a UTI cause this in the first place? It makes no sense.
Please give your suggestions.
Hi,
Welcome back to icliniq.com.
Thank you for your query.
Please share the urine culture report with me. You could repeat it after a week for earlier sample collection and recheck. I have already stated that the clinical scenarios can be diametrically opposite regarding urine routine and urine culture. This can cause clinical confusion. Also, besides these reports, symptoms are important for UTI diagnoses. The only urinary symptom you mentioned is incontinence, which could also be due to advanced age. Does she have signs and symptoms such as pyrexia, a burning sensation while passing urine, and pubic or flank pain?
If so, treating with a five-day course of appropriate UTI-specific, bacteria-sensitive antibiotics is best. If not, an eight days course of urinary antiseptic could be useful, but first, please share the culture report.
I hope this helps.
Kindly follow up with the culture reports.
Take care.
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Infectious Diseases
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