Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Sampling and evaluation of voided urine in the diagnosis of urinary tract infection in adults

Alain Meyrier, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Urine collected in a normal individual by suprapubic aspiration of the bladder is sterile and does not contain leukocytes. This method represents the gold standard in the diagnosis of urinary tract infection (UTI) [1,2]. It is, however, not performed routinely in clinical practice. Instead, urine samples are generally obtained after natural micturition; in this setting, some degree of artifactual contamination with normal urethral organisms must be accepted.

This topic discusses the collection and analysis of voided urine for the diagnosis of UTIs in adults. More detailed discussions on acute uncomplicated and complicated UTI in women and men and children are found elsewhere:

(See "Acute uncomplicated cystitis and pyelonephritis in women".)

(See "Acute uncomplicated cystitis and pyelonephritis in men".)

(See "Acute complicated cystitis and pyelonephritis".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 01, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Stamm WE, Wagner KF, Amsel R, et al. Causes of the acute urethral syndrome in women. N Engl J Med 1980; 303:409.
  2. Bailey RR, Little PJ. Suprapubic bladder aspiration in diagnosis of urinary tract infection. Br Med J 1969; 1:293.
  3. LaRocco MT, Franek J, Leibach EK, et al. Effectiveness of Preanalytic Practices on Contamination and Diagnostic Accuracy of Urine Cultures: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis. Clin Microbiol Rev 2016; 29:105.
  4. Baerheim A, Digranes A, Hunskaar S. Evaluation of urine sampling technique: bacterial contamination of samples from women students. Br J Gen Pract 1992; 42:241.
  5. Lifshitz E, Kramer L. Outpatient urine culture: does collection technique matter? Arch Intern Med 2000; 160:2537.
  6. Schneeberger C, van den Heuvel ER, Erwich JJ, et al. Contamination rates of three urine-sampling methods to assess bacteriuria in pregnant women. Obstet Gynecol 2013; 121:299.
  7. Gupta K, Trautner B. In the clinic. Urinary tract infection. Ann Intern Med 2012; 156:ITC3.
  8. Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med 2012; 366:1028.
  9. Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002; 287:2701.
  10. Koeijers JJ, Kessels AG, Nys S, et al. Evaluation of the nitrite and leukocyte esterase activity tests for the diagnosis of acute symptomatic urinary tract infection in men. Clin Infect Dis 2007; 45:894.
  11. McNeeley SG, Baselski VS, Ryan GM. An evaluation of two rapid bacteriuria screening procedures. Obstet Gynecol 1987; 69:550.
  12. Pfaller MA, Koontz FP. Laboratory evaluation of leukocyte esterase and nitrite tests for the detection of bacteriuria. J Clin Microbiol 1985; 21:840.
  13. Pappas PG. Laboratory in the diagnosis and management of urinary tract infections. Med Clin North Am 1991; 75:313.
  14. Williams GJ, Macaskill P, Chan SF, et al. Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis. Lancet Infect Dis 2010; 10:240.
  15. Devillé WL, Yzermans JC, van Duijn NP, et al. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urol 2004; 4:4.
  16. St John A, Boyd JC, Lowes AJ, Price CP. The use of urinary dipstick tests to exclude urinary tract infection: a systematic review of the literature. Am J Clin Pathol 2006; 126:428.
  17. Little P, Turner S, Rumsby K, et al. Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study. Health Technol Assess 2009; 13:iii.
  18. Meister L, Morley EJ, Scheer D, Sinert R. History and physical examination plus laboratory testing for the diagnosis of adult female urinary tract infection. Acad Emerg Med 2013; 20:631.
  19. Little P, Turner S, Rumsby K, et al. Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women. Br J Gen Pract 2010; 60:495.
  20. Hessdoerfer E, Jundt K, Peschers U. Is a dipstick test sufficient to exclude urinary tract infection in women with overactive bladder? Int Urogynecol J 2011; 22:229.
  21. Stamm WE. Measurement of pyuria and its relation to bacteriuria. Am J Med 1983; 75:53.
  22. Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis 2004; 38:1150.
  23. Kunin CM, White LV, Hua TH. A reassessment of the importance of "low-count" bacteriuria in young women with acute urinary symptoms. Ann Intern Med 1993; 119:454.
  24. Komaroff AL. Acute dysuria in women. N Engl J Med 1984; 310:368.
  25. McDonald MI, Lam MH, Birch DF, et al. Ureaplasma urealyticum in patients with acute symptoms of urinary tract infection. J Urol 1982; 128:517.
  26. Eagan JW. Urinary tract cytology. In: Uropathology, Hill GS (Ed), Churchill Livingstone, Philadelphia 1989. Vol 2, p.873.
  27. Gupta K, Hooton TM, Roberts PL, Stamm WE. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med 2001; 135:9.
  28. Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis 2007; 45:273.
  29. Gupta K, Hooton TM, Roberts PL, Stamm WE. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med 2007; 167:2207.
  30. McKinnell JA, Stollenwerk NS, Jung CW, Miller LG. Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. Mayo Clin Proc 2011; 86:480.
  31. KASS EH. Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians 1956; 69:56.
  32. Platt R. Quantitative definition of bacteriuria. Am J Med 1983; 75:44.
  33. Pollock HM. Laboratory techniques for detection of urinary tract infection and assessment of value. Am J Med 1983; 75:79.
  34. SANFORD JP, FAVOUR CB, MAO FH, HARRISON JH. Evaluation of the positive urine culture; an approach to the differentiation of significant bacteria from contaminants. Am J Med 1956; 20:88.
  35. Tapsall JW, Taylor PC, Bell SM, Smith DD. Relevance of "significant bacteriuria" to aetiology and diagnosis of urinary-tract infection. Lancet 1975; 2:637.
  36. Stamm WE, Counts GW, Running KR, et al. Diagnosis of coliform infection in acutely dysuric women. N Engl J Med 1982; 307:463.
  37. Naber KG, Schito G, Botto H, et al. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol 2008; 54:1164.
  38. De Backer D, Christiaens T, Heytens S, et al. Evolution of bacterial susceptibility pattern of Escherichia coli in uncomplicated urinary tract infections in a country with high antibiotic consumption: a comparison of two surveys with a 10 year interval. J Antimicrob Chemother 2008; 62:364.
  39. Heytens S, Boelens J, Claeys G, et al. Uropathogen distribution and antimicrobial susceptibility in uncomplicated cystitis in Belgium, a high antibiotics prescribing country: 20-year surveillance. Eur J Clin Microbiol Infect Dis 2017; 36:105.
  40. Hooton TM, Roberts PL, Cox ME, Stapleton AE. Voided midstream urine culture and acute cystitis in premenopausal women. N Engl J Med 2013; 369:1883.
  41. Heytens S, De Sutter A, Coorevits L, et al. Women with symptoms of a urinary tract infection but a negative urine culture: PCR-based quantification of Escherichia coli suggests infection in most cases. Clin Microbiol Infect 2017; 23:647.