Sensitivity of Extended Cultures in Diagnosing Urinary Tract Infections

In 2014, Hilt, Evann et al published a study called "Urine is not sterile," in which it was
found via PCR and extended urine cultures, there is a microbiome that exists within the
urinary bladder. In this study, 92% of the bacteria failed to be identified by a standard
urine culture but 80% were identified with extended urine cultures. In further explorations
of the significance of this microbiome, Pearce, Meghan et al. found that the female bladder
consists of increased abundance of bacteria in patients with UUI; including Gardnerella and
Lactobacilus gasseri. Then in 2015, a study by Thomas-White, Krystal et al. found that
patients with urge urinary incontinence (UUI) who responded to treatment with Solifenacin had
fewer and less diverse communities of bacteria when evaluated by PCR and extended urine
cultures.

The clinical significance of the bacteria identified is not well understood. However, these
studies show that the presence of bacteria is being missed by standard cultures. Dune et al.
found that of patients with UTI symptoms, 27.5% were standard culture negative but extended
quantitative urine culture positive. This demonstrates that practitioners may be overlooking
urinary tract infections in patients with frequency and urgency. Therefore, if bacteria
within the urine can be detected with extended cultures, can this technique be used to
improve detection and treatment of urinary infections in patients with symptoms of frequency
and urgency?

The hypotheses states that extended urine cultures are more sensitive in the identification
of urinary tract infections in patients with symptoms of urgency and frequency. The secondary
hypothesis is that treatment of the uropathogen identified on extended urine cultures will
improve patient symptoms.

Inclusion Criteria:

- 18 y/o-70 y/o

- Able to consent

- Urgency /Frequency

- Urge incontinence

- PUF score ≤ 4

- Bother questionnaire #2 or #3 answered either "a moderate amount" or "a lot"

Exclusion Criteria:

- Pregnant

- Pelvic radiation

- Chronic pelvic pain

- Urinary retention

- Greater than Stage 2 prolapse

- Renal calculi

- Recurrent UTI (2 in 6 months)

- Immunosuppressed

- Neurologic disorder

- No antibiotics in the past 4 weeks