Urine Culture
Also Consider: Abnormal lab test, Culture Results, Urinalysis, Symptoms of UTI
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A urine culture is “positive” if it reports greater than 100,000 cfu/ml of a bacteria species.
Cultures with more than one species of bacteria are likely contaminated and may need to be repeated.
The results of a Urinalysis done on the same urine sample as the culture is needed to interpret the urine culture result.
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Symptoms or Signs of Urinary Tract Infection
Pain with urination (dysuria)
Tenderness or pain in the lower abdomen / suprapubic / pelvic region, or the back / flank region
Visible blood in urine (hematuria)
Pain in testes or purulent drainage (pus) from urethra
New or worsening urinary urgency, frequency, incontinence
Acute mental status change (lethargy, unresponsiveness, increased confusion)
Not eating or drinking as much as usual
Acute decline in ADL abilities
Chills, rigors, or diaphoresis (sweats)
GI: Nausea, vomiting, constipation, abdominal distention or tenderness
GU: New or worsened incontinence, pain with urination, blood in urine, Pain/tenderness in testes, bladder scan
Fingerstick glucose (patients with diabetes)
Presence and function of urinary catheter
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Immediately notify the medical staff & resident representative
ALL of the below:
WBC on Urinalysis greater than 9
Culture with greater than 100,000 cfu.ml of a bacteria species
Temperature recently greater than 100°F or 2°F over baseline, OR any of the above symptoms of Urinary Tract Infection
Patient not receiving antibiotic or receiving an antibiotic that the identified bacteria is not sensitive to.
Notify medical staff & resident representative within the next 16 hours.
Patient is on an antibiotic and the urine culture does not show greater than 100,000 cfu/ml of a bacteria species
Notify medical staff at the next regular rounds
Other abnormal urine culture
SBAR Report
Situation: "Urine culture” (positive) (negative) (symptoms of UTI) (fever of ___) (patient not on antibiotic) (patient on antibiotic) (urinalysis showed >9 WBCs)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
Reason the test was done
Abnormal Vital Signs
MOLST / Advance Directives
Recent illness, antibiotics
General observation of patient condition
Ability to take oral medications or presence of feeding tube
Diuretic Use & recent dose changes
Fluid restriction, thickened liquids
Presence of urinary catheter
Tube feeding rate and water flush orders
Availability of IV or clysis hydration (i.e., PICC line)
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: CBC with manual diff, CMP/Chem14, Lactic Acid, Blood cultures
INR if patient is on warfarin
Antibiotic if infection is diagnosed
Stop antibiotic if urine culture is negative
Repeat urine culture because of contamination. Straight catheterization for urine sample for urinalysis and culture (unless patient is able to collect clean-catch, midstream urine). For residents with indwelling catheter: change the catheter first and then obtain sample from the new catheter
Increase tube feed water flushes
Change fluid restriction orders
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs every 4-8 hrs for 2-3 days
Offer fluids frequently
Place on Intake & Output monitoring
Oral, IV, or subcutaneous fluids if needed for hydration
Place on 24-hour report for 2-3 days
Obtain lab results (if ordered), and notify medical as needed of:
Significantly abnormal values in lab tests (refer to appropriate Situation)
INR if antibiotic therapy ordered and the patient is on warfarin (Coumadin).
Implement infection control measures if indicated
If an antibiotic is started, perform an “Antibiotic Time Out” after 2-3 days of antibiotic treatment
If needed, revise the duration given the response to treatment.
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative daily
DO NOT perform repeat urine culture to test for cure
2025-04-27
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