title: Reflex testing of male urine specimens misses few positive cultures may reduce unnecessary testing of normal specimens.
abstract: OBJECTIVE
  To determine the predictive values of leukocyte count for the presence of a positive urine culture in ambulatory male urology patients. Many institutions have adopted a practice of "reflex testing" urine samples, in which urine culture is only performed if a threshold number of leukocytes (WBCs [white blood cells]) is present.
  
  
  METHODS
  We performed a retrospective chart review of all male patients who presented to our tertiary-care urology clinic in 2006. Only those with both a urinalysis and urine culture performed were included in this study. A urine culture was considered positive if at least 10,000 colonies of a uropathogen were present. Data were tabulated and analyzed using SPSS V15.0 software.
  
  
  RESULTS
  Of 874 patients, 176 (20%) urine cultures were positive. WBCs were present at a concentration of at least 5/hpf (high power field) in 367 (42%) of all specimens and in 163 of 176 (93%) positive specimens, but were present at lower concentrations in 13 specimens with positive cultures. The presence of >5 WBC/hpf had a positive predictive value of 47%, and a negative predictive value of 97% for positive culture.
  
  
  CONCLUSIONS
  Reflex urine testing, in which cultures are done on urine specimens with >5 WBC/hpf, would have missed 7% of positive urine cultures, while avoiding 69% of all cultures. Reflex testing may be appropriate in most ambulatory urology patients.
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinois 60153, USA. csfok@lumc.edu
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fok
authors.forename: Mary P
authors.initials: MP
authors.lastname: Fitzgerald
authors.forename: Thomas
authors.initials: T
authors.lastname: Turk
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mueller
authors.forename: Leslie
authors.initials: L
authors.lastname: Dalaza
authors.forename: Paul
authors.initials: P
authors.lastname: Schreckenberger
mesh_terms: D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D016482:Urinalysis / Q000706:statistics & numerical data*; D014556:Urine / Q000166:cytology* / Q000382:microbiology*