Urinary Tract - Bacterial IdentificationLaboratory testing algorithm for E. coli, Proteus mirabilis, Providencia stuartii, Serratia marcescens, Enterobacter cloacae, Staphylococcus saprophyticus, and Enterococcus Hover over the animation to start / stop rotationLarge Gram Negative - - Large Rods Oxidase Test - Negative ![]() ![]() Enterobacteriaceae Large Gram Negative Rods MacConkey Agar - Positive Lactose Positive Indole Test - Green sheen on EMB Agar ![]() ![]() ![]() Escherichia coli Large Gram Negative Rods MacConkey Agar - Negative Lactose Swarming Growth on Blood Agar H2S positive - - Indole negative ![]() ![]() ![]() Proteus mirabilis Large Gram Negative Rods MacConkey Agar - Negative Lactose H2S negative - - Indole Positive ![]() ![]() ![]() Providencia stuartii Large Gram Negative Rods MacConkey Agar - Negative Lactose Nutrient Agar Red Pigment - - Citrate positive ![]() ![]() ![]() Serratia marcescens Large Gram Negative Rods MacConkey Agar - Positive Lactose Indole Negative - - Urea positive ![]() ![]() ![]() Enterobacter cloacae Gram positive Cocci in Clusters Catalase Positive - - Coagulase Negative Novobiocin Test Positive ![]() ![]() ![]() Staphylococcus saprophyticus Gram positive Cocci in Chains Catalase Negative Gamma (no) Hemolysis on Blood Agar Bile Esculin Agar Positive ![]() ![]() ![]() Enterococcus |
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Urinary tract infections (UTIs) are common, and most are uncomplicated. Bacteria are the most common organisms implicated, most often the Enterobacteriaceae, and the majority are due to E. coli. Though many species of bacteria can be implicated in UTIs, the most common are given above. Uncomplicated UTIs can be treated empirically. Infections that are recurrent or more severe can be assessed with microbiologic culture and antibiotic sensitivity to choose the best treatment. Since collection of urine for culture by voiding is inherently a nonsterile method with contamination by perineal bacteria, then one criterion for assessment of a true infection is a "colony count" performed using a calibrated loop, with 0.001 mL of the urine sample plated onto culture media and incubated. The number of colonies present is multiplied by 1000. In this example, there are over 100,000 colonies/mL. This number, >105 for one organism, is considered significant. A blood agar plate for colony counting is shown below: ![]() Antibiotic sensitivity testing with a Kirby-Bauer plate us shown below illustrating the diffusion disk method in which antibiotic-impregnated disks are placed on a culture plate with the organism, and the zone of inhibition of growth is measured, compared to controls. In general, less than 2 mm of inhibition defines resistance, while a large zone of inhibition suggests sensitivity. Smaller zones imply intermediate sensitivity. In the example below, the organism is sensitive to Amikacin and Penicillin, with intermediate sensitivity to Gentamicin and Cefotaxime, with resistance to Methicillin, Vancomycin, and Nafcillin. ![]() |