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Cost Containment: Why Unnecessary Urine Cultures?
691
LETTERS TO THE EDITOR
possibility that subsequent specimens also may be contaminated and that care should be used in interpreting any findings on culture. Respectfully, Roger Hole North Ormesby Hospital Middlesbrough Cleveland TS3 6HJ, England
To the Editor. I found this article noteworthy and interesting but I have 2 critical comments. by the authors. They indicate tho.t uinitial vvere collected by the to the routine :i:nessenge:r They do not :ceve;:;l the collection for these ,spe,,w.u,:w, the ir,.terva1 between collection and technologist or ce
the [Lpeat specirr:.ens
stiH not the :;pecin1.eas. It
'f'be study -svouid hH\re bez:-:m. rr10Te vvc:cthwhile had had scJlection, a stated_ collection and an2tlysis ar:d Iastly at least 2 diif-er::;nt .~c..,c·n·oc·~ c.t eacb 1.1:rirr;1ry sechrnent {these persons shGuld or a registered_ )~echnologist) so that on the reading of th-2 sedirnent co1,:.1d he uu%1m,20, senteru:e of abstract statssj ''These data indicate that for pyuria 2:.nd infection one should either obtain a clean .:-:atch specimen for examination of u:rincsy setli:;.uent. n. This statement is son1e·what facetious and/or naive. IVIost of us in vv,u,~·w•,c-: would advocate clean catch rnidstream 1
1
0
same urine specimen were selected for study. For the purpose of the study it was assumed that the calibrated loop laborntory culture was 100 per cent accurate and that all deviations other techniques represented falsely positive or negative studie3. this basic premise is invalid and, in fact, the dipslide and ~mear correlated as contrasted to the culture in a significant num'·,er of pat,ie,,ts. The resuits of the study indicated that !"· p3',i.e:1ts ,, ,th colony counts > 10" (202 patients) the correlation fo, per cent and for the stained smear it was 90 pe, ,;,h colony counts of 104 (34 patients) the resp";,,ih· cent for the dipslide and 56 cent fer vvith colony counts cf no < Hf '~A.2 v,,ras approximately 93 per cent £~3r for the stained smeaT. must question 'Nhethe:r indicated in :routine scr-eeniEg or evaluaticr:., e"l,rcn if it vi/ere to be 10 per cent m_0re accurate_ Si:ice most infections respond to 3,hnost all anti .. rnedical dollars could be sa-vcd by sirnpl21 sn excellent inex.pensiv2_ the diagnosis of infection. l1ow·faet th.at. the stained s:11.ez_:r) <3 rninutes to behooves the busy basic irnportant those and ~t is techr2sidency tr2.ining to these tried aEd proved niques and not perrnit the resident to follow in cf so rnany of who depend more and more on the laboratory and clinical exp~rtise.
s_pecin1ens fC.:r s.n.d., in 8ddition, for fernal2 patients \Ve would require a specirnen if pyuria ha_d bs~n noted in a clean catx::h n.1.idst:cearn specirnen.
Respectfully, Victor Braren Department ',/anderbilt l'lashuille) Tennessee Our randorn urine ~µ,eectrneIJ,~ were collected in clean 250 ml. plastic with a cardboard lid. not cleansed. The
and of the amount observation fields, was performed and The conclusions made from our data relate to first screening specimen for pyuria, in which we found that the criteria used to determine the presence of significant pyuria was, indeed, dependent on whether a random or CCMS specimen was collected. Doctor Braren's comment regarding a catheterized specimen may, indeed, be an accepted diagnostic procedure in the followup of a patient found to have significant pyuria in the first screening specimen. Therefore, it is important that the criteria used for screening of pyuria correlate with the type of specimen.
COST CONTAINMENT: WHY UNNECESSARY URINE CULTURES? To the Editor. In the average teaching as well as in community hospitals the majority of urine cultures processed demonstrate no bacterial grnwth. When the cost of a urine culture exceeded the cost of an office visit it became apparent that it was time to re-evaluate the methods of investigating patients with urinary tract symptomatology. During the last 4 years patients in a private urologic office were evaluated by a combination of 1) the calibrated loop laboratory culture, 2) an inexpensive plastic dipslide coated on one side with eosin-methylene blue and on the other with cystine-lactose electrolyte deficient media (the eosin-methylene blue medium permits the grnwth of gram-negative bacilli, while the cystine-lactose electrolyte deficient medium provides optimum growth for gram-negative and gram-positive organisms) and 3) an aliquot of the midstream or catheterized urine is centrifuged) a of the sediment being placed on a glass slide, heat fixed and with methylene blue. On.ly those patients in ·wb.01.11 all 3 studies \Vere done ·with the
COMPUTED TOIVlOGR1.\PHY 1\S A DIA.Gl'JOSTIC TECHI\JIQUE To the Editor. I write in associates and their evaluation the use of 1 In the editorial comment following for urology-radiology groups v,ith ffCOC>ODo''90 per cent. We agree that more of these prospective :radiological-surgical studies are required. However, we believe that CT scanning has been demonstrated to be a safe, easily tolerated technique for the evaluation of pelvic and renal disease. 2
Respectfully, Sanford P. Temes Section of Urology, Department of Surgery Malcolm Grow USAF Medical Center Andrews Air Force Base, Maryland 20331 1. Bonney, W. W., Chiu, L. C. and Culp, D. A.: Computed tomography of the pelvis. J, Urol., 120: 457, 1978. 2. Seidelmann, F. E., Cohen, W. N., Bryan, P. J., Ternes, S. P., Kraus, D. and Schoenrock, G.: Accuracy of CT staging of bladder neoplasms using the gas-filled method: report of 21 patients with surgical confirmation. Amer. J. Roentgen., 130: 735, 1978.
CONDYLOMA ACUMINATUM
To the Editor. One condyloma acuminatum, two condylomata acuminata but not, please, condyloma acuminata. Yours in the lonely battle for avoidance of elementary errors m the plural of Greek nouns. Respectfully, Fl. de Glanville PD. Box 30125 1-Jairobi, Kenya
LETTERS TO THE EDITOR
possibility that subsequent specimens also may be contaminated and that care should be used in interpreting any findings on culture. Respectfully, Roger Hole North Ormesby Hospital Middlesbrough Cleveland TS3 6HJ, England
To the Editor. I found this article noteworthy and interesting but I have 2 critical comments. by the authors. They indicate tho.t uinitial vvere collected by the to the routine :i:nessenge:r They do not :ceve;:;l the collection for these ,spe,,w.u,:w, the ir,.terva1 between collection and technologist or ce
the [Lpeat specirr:.ens
stiH not the :;pecin1.eas. It
'f'be study -svouid hH\re bez:-:m. rr10Te vvc:cthwhile had had scJlection, a stated_ collection and an2tlysis ar:d Iastly at least 2 diif-er::;nt .~c..,c·n·oc·~ c.t eacb 1.1:rirr;1ry sechrnent {these persons shGuld or a registered_ )~echnologist) so that on the reading of th-2 sedirnent co1,:.1d he uu%1m,20, senteru:e of abstract statssj ''These data indicate that for pyuria 2:.nd infection one should either obtain a clean .:-:atch specimen for examination of u:rincsy setli:;.uent. n. This statement is son1e·what facetious and/or naive. IVIost of us in vv,u,~·w•,c-: would advocate clean catch rnidstream 1
1
0
same urine specimen were selected for study. For the purpose of the study it was assumed that the calibrated loop laborntory culture was 100 per cent accurate and that all deviations other techniques represented falsely positive or negative studie3. this basic premise is invalid and, in fact, the dipslide and ~mear correlated as contrasted to the culture in a significant num'·,er of pat,ie,,ts. The resuits of the study indicated that !"· p3',i.e:1ts ,, ,th colony counts > 10" (202 patients) the correlation fo, per cent and for the stained smear it was 90 pe, ,;,h colony counts of 104 (34 patients) the resp";,,ih· cent for the dipslide and 56 cent fer vvith colony counts cf no < Hf '~A.2 v,,ras approximately 93 per cent £~3r for the stained smeaT. must question 'Nhethe:r indicated in :routine scr-eeniEg or evaluaticr:., e"l,rcn if it vi/ere to be 10 per cent m_0re accurate_ Si:ice most infections respond to 3,hnost all anti .. rnedical dollars could be sa-vcd by sirnpl21 sn excellent inex.pensiv2_ the diagnosis of infection. l1ow·faet th.at. the stained s:11.ez_:r) <3 rninutes to behooves the busy basic irnportant those and ~t is techr2sidency tr2.ining to these tried aEd proved niques and not perrnit the resident to follow in cf so rnany of who depend more and more on the laboratory and clinical exp~rtise.
s_pecin1ens fC.:r s.n.d., in 8ddition, for fernal2 patients \Ve would require a specirnen if pyuria ha_d bs~n noted in a clean catx::h n.1.idst:cearn specirnen.
Respectfully, Victor Braren Department ',/anderbilt l'lashuille) Tennessee Our randorn urine ~µ,eectrneIJ,~ were collected in clean 250 ml. plastic with a cardboard lid. not cleansed. The
and of the amount observation fields, was performed and The conclusions made from our data relate to first screening specimen for pyuria, in which we found that the criteria used to determine the presence of significant pyuria was, indeed, dependent on whether a random or CCMS specimen was collected. Doctor Braren's comment regarding a catheterized specimen may, indeed, be an accepted diagnostic procedure in the followup of a patient found to have significant pyuria in the first screening specimen. Therefore, it is important that the criteria used for screening of pyuria correlate with the type of specimen.
COST CONTAINMENT: WHY UNNECESSARY URINE CULTURES? To the Editor. In the average teaching as well as in community hospitals the majority of urine cultures processed demonstrate no bacterial grnwth. When the cost of a urine culture exceeded the cost of an office visit it became apparent that it was time to re-evaluate the methods of investigating patients with urinary tract symptomatology. During the last 4 years patients in a private urologic office were evaluated by a combination of 1) the calibrated loop laboratory culture, 2) an inexpensive plastic dipslide coated on one side with eosin-methylene blue and on the other with cystine-lactose electrolyte deficient media (the eosin-methylene blue medium permits the grnwth of gram-negative bacilli, while the cystine-lactose electrolyte deficient medium provides optimum growth for gram-negative and gram-positive organisms) and 3) an aliquot of the midstream or catheterized urine is centrifuged) a of the sediment being placed on a glass slide, heat fixed and with methylene blue. On.ly those patients in ·wb.01.11 all 3 studies \Vere done ·with the
COMPUTED TOIVlOGR1.\PHY 1\S A DIA.Gl'JOSTIC TECHI\JIQUE To the Editor. I write in associates and their evaluation the use of 1 In the editorial comment following for urology-radiology groups v,ith ffCOC>ODo''
Respectfully, Sanford P. Temes Section of Urology, Department of Surgery Malcolm Grow USAF Medical Center Andrews Air Force Base, Maryland 20331 1. Bonney, W. W., Chiu, L. C. and Culp, D. A.: Computed tomography of the pelvis. J, Urol., 120: 457, 1978. 2. Seidelmann, F. E., Cohen, W. N., Bryan, P. J., Ternes, S. P., Kraus, D. and Schoenrock, G.: Accuracy of CT staging of bladder neoplasms using the gas-filled method: report of 21 patients with surgical confirmation. Amer. J. Roentgen., 130: 735, 1978.
CONDYLOMA ACUMINATUM
To the Editor. One condyloma acuminatum, two condylomata acuminata but not, please, condyloma acuminata. Yours in the lonely battle for avoidance of elementary errors m the plural of Greek nouns. Respectfully, Fl. de Glanville PD. Box 30125 1-Jairobi, Kenya