Outpatient urine culture: does collection technique matter?

Arch Intern Med. 2000 Sep 11;160(16):2537-40. doi: 10.1001/archinte.160.16.2537.


Background: Dysuria is one of the most common presenting complaints of young women, and urinalysis is one of the most common laboratory tests performed. Despite the fact that the midstream clean-catch technique is commonly used for urine collection, contaminated urine cultures occur with distressing regularity. The midstream clean-catch technique is time-consuming to explain, frequently not performed correctly by patients, costly for supplies, often embarrassing for patients and staff, and of unproven benefit. Therefore, we designed a study to compare various methods of obtaining specimens for culture from acutely dysuric young women.

Methods: A total of 242 consecutive female patients who presented with symptoms suggestive of a urinary tract infection were randomized into 3 groups. The first group (n = 77) was instructed to urinate into a clean container. No cleansing was done, and the specimen was not obtained midstream. The second group (n = 84) was instructed to collect a midstream urine sample with perineal cleansing and spreading of the labia. In an attempt to decrease contamination from the vagina, the third group (n = 81) was given the same instructions as group 2, with the addition of using a vaginal tampon. Contamination rates were calculated for all 3 groups.

Results: Contamination rates for the 3 groups were nearly identical (29%, 32%, and 31%, respectively). Comparing the no-cleansing group with the combined cleansing, midstream groups also showed no difference in contamination rates (28.6% and 31.5%, respectively, with P =.65).

Conclusions: In young, outpatient women with symptoms suggestive of a urinary tract infection, the midstream clean-catch technique does not decrease contamination rates.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Middle Aged
  • Specimen Handling / methods*
  • Urinalysis / methods*
  • Urinary Tract Infections / diagnosis*