Urine Reflex to C&S Updates (Culture if Indicated)

We are preparing to add an additional bacteria screening test to our Reflex to C&S panel in
order to improve our Negative Predictive Value and to strengthen our final determination of
calling a urine “negative” and therefore would not reflex it to a C&S (ID & Sensitivity).

The additional test is the UriScreen. We will be adding the UriScreen to our “Urinalysis with
Reflex to C&S Panel”. The UriScreen detects catalase. Catalase is found in both WBCs and
Bacteria. The best Positive Predictive Value of a potential UTI that would indicate a reflex to a
C&S is the presence of both WBCs (pyuria) and Bacteria (bacteriuria). Normal, clean urine has
no significant catalase activity.

By the addition of the UriScreen to our Urinalysis with Reflex to C&S Panel we will be able to
significantly improve our Negative Predictive Value of a potential UTI and therefore more
confidently rule out the reflex to a C&S.

In light of the above addition, we will be making the following ordering adjustments.

Currently we are ordering the following Panels for the UA with reflex to C&S

45 Urinalysis w/ Microscopic (SHV)
50 Urinalysis w/ Microscopic (PH)

Beginning January 2020, we will begin ordering the following Panels for the Urinalysis Reflex to C&S orders.

2702 UR C&S Reflex Panel (PH)
2704 UR C&S Reflex Panel (SHV)

The New C&S Profile to be reflexed to will be UTI-ID & Sensitivity by PCR (MA). It is loaded in Careevolve and in the Labdaq Urine_C&S Ordering Tab if you need to order it individually.

The new Panel # 7503 UTI ID & Sensitivity by PCR (MA) will be reflexively ordered by Labdaq when any of the following triggers occur

  • Positive Nitrite
  • Positive Leukocyte Esterase
  • Positive Catalase

The (MA) at the end of the Panel name is for the new reference lab MedArbor. We do not currently have an interface with MedArbor but have begun working on it.

The plan is to send each Positive Reflex sample to MedArbor to be analyzed by a new technology known as PCR. The new PCR technology is faster and better and we should be able to cut a day or two off of our turnaround time.

The sample preparation should essentially be the same. The plan is to place a filled (with urine) and labeled Gray top tube with a requisition into a plastic sample bag and send them up to Shreveport for UPS to pick up between 5-6PM.

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