Do I need antibiotics if it says mixed flora in the urine culture …

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    Let your doctor decide what to do, as it is the whole picture which decides the correct actions.

    But the general answer to this question is a mixed flora in the urine culture means the urine sample is polluted by bacteria from other parts of your body. Especially women are prone to have their urine samples contaminated by bacteria from the vaginal discharge. It is needed to have instructions of how to take the urine sample not being contaminated by the vaginal discharge. This procedure is called “A washing, mid stream urine sample “.

    If having a Lower Urinary Tract Infection “, this most often is caused by only one bacteria strain at the time.

    There of course are exceptions of this.

    In short: If you are not having symptoms of a UTI, the only finding is a mixed urine culture, usually it is not necessary to use antibiotics.

    If you have symptoms like fever, often having to urinate or a burning pain when and after urimating, you should have a new urine sample taken and be instructed how to take it.

    Again:! Follow the advices from your doctor!

    No, you don’t.

    Urine is a difficult specimen to deal with. It almost always gets contaminated by bacteria on the skin or at the tip of the urethra.

    There are 2 rules to say that whatever grows is not a contaminant;

    1. It must not be a mixture of different organisms. There should be only one (or at most two) type of organism grows.
    2. That organism must be present at a significant amount. Normally the significant amount is 10^5 (or 100,000) CFU/ml. THe number may be lower than this if there are any additional conditions.

    Also, it is only a lab result. What matter is that you (the patient) have any symptoms indication of infection. If yes, you should see the doctor and recollect the urine to find the true culprit.

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    Mixed flora is basically a nice way of saying there are skin bacteria in this sample and it wasn’t obtained in the most clean way possible.

    You may have to repeat the urine specimen if your doctor felt that you had a urinary tract infection. However, if the pretest probability of disease was low or the specimen was sent by mistake, there’s nothing to do. I mean, no antibiotic is needed.

    I was asked to update the answers to this question. The other answers are pretty complete.

    Bit I would not agree we should sound critical of women who cannot give a “clean catch” specimen. If it were easy, all women would do it right. Not being a woman I struggled to explain how a women should do this method of urine collection. I know many women don’t check themselves with a mirror and might no know the location of the opening of the urethra.

    This paragraph is graphic. Do we as medical practionners know whether women always give a clean stream when the labia are spread out of the way? If the urine dribbles from the urethra to the vaginal mucosa to the cup, all bets are off. And what if it requires two hands to spread the labia? Who holds the specimen cup. Maybe voiding into a plastic “hat” solves this problem, but if that hat is not sterile, that may be the source of the contamination we call mixed flora.

    Other issue: how many hours passed between the voiding of the specimen and preparing the culture? Bacteria multiply quickly in urine.

    For this reason a four hour nitrite test on the urine may help us to better interpret the results. If we have a urine that has been in the bladder 4 hours and promptly shows nitrite (from the action of bacteria on the urea), I think most clinician would disregard the “mixed flora” report and treat the patient with an antibiotic. BTW nitrite is on the usual dipsticks and you can also buy a nitrite and white blood cell dipticks about 3 for $10 to $12 at pharmacies (Brand name AZO test strips). A positive nitrite on a freshly tested urine that has been in the bladder for 4 hours is highly suggestive of infection or the urinary system, though not all bacteria will split urea to form nitrite.

    Please let me know if this post gave you some new information or on the other hand is not well explained.

    Between the vaginal opening the the clitoris.

    Flora refers to the organisms that we see when we examine it in the lab. Mixed means we see both what we expect to see (the normal ones) and what are not supposed to be there (the ones we should see for example, in the skin or the vagina or anus). Generally speaking, mixed flora means contamination of the urine specimen, hence it does not help in any way to make good decision how to treat. Why is this so? There is supposed to be just one foreign organism — usually the pathologic one, that remains in urine if it is truly infected. Because being pathologic and “strong” at that, it discourages or renders difficult the growth of other ones, especially those normal ones. It’s like an invasion. It kills all the guards and other armies. Hence, if we see mixed organisms, where is the pathology? They seem to be friendlies living in harmony….

    However, there appears to be some evidence that mixed flora may represent an actual mixed infection, especially in certain chronic conditions like the presence of foreign body like a catheter. Thus it is more prudent to treat them as such.

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    Antibiotics are chemical substances produced and secreted out in the environment by the microbes as a defense against other organisms in the surrounding for their survival.

    The antibiotics cannot affect the micro-organism because-

    1. Often, the genes producing these antibiotics are clustered in the same operons as the genes which provide resistance against the same antibiotic to the organism to protect it from the action of it’s own antibiotic
    2. Bacteria posses something known as an efflux pump which literally acts as a pump to drain away the toxic materials out of the cell, thus conferring resistance

    Nature has been kind enough to let each and every creature develop it’s own defense mechanism and as the Darwin’s law states, it’s the survival of the fittest; for which our friendly little microscopic beings have always been ahead.

    The answer is definitely a yes and this is because urine is supposed to be sterile devoid of any living organism. When organisms (flora) are found in urine they indicate that there is a problem.

    It is complicated. When a male provides a urine specimen for a culture, the best technique for acquisition is to cleanse the head of the penis and obtain the urine well after the urine starts and before it stops flowing (clean catch/mid-stream). People don’t realize that the interpretation of the urine culture is not binary. If the male has greater than 10,000colonies of bacteria/cc of urine growing after providing the clean catch mid stream urine that male would have an 80% probability of having a true urine infection. So the result has to be interpreted in statistical terms. Now a female has “indoor plumbing” so it is not as easy to provide a suitable urine specimen. As the urine leaves the urethra, it still has to transit the introitus where vaginal bacteria can become part of the specimen and subsequently grow on the agar plate. For women then, a voided urine specimen should demonstrated greater than 100,000 colonies of bacteria/ cc of urine to have a 90–95% chance of representing a “true” urine infection. For the matter at hand we are asked to interpret the significance of “mixed flora” on the urine culture. The medical student will observe that most urine infections occur when one bacteria takes off growing and, as such, it is the only bacteria to be found growing on the plate. When multiple bacteria are growing on the plate, the medical student will dismiss the culture as contaminated with skin bacteria during collection which happens often in females vs males as described above. In this instance we have symptoms as well as a culture that most often would be considered negative as it showed numerous bacteria to be present. Those symptoms are important. As a Pediatric Urologist I often see children , most often girls, who have symptoms of discomfort while voiding. On examination I often directly observe a very red, irritated bottom. When I spread the labia of such a child, I can see the urine just pouring out of the introitus. I sense that the child voids and retains urine in the vaginal area, this causes secondary irritation such that burning on urination develops. The culture from such a child might show multiple bacteria, but she has a symptom (burning on urination) that is associated with UTI’s. I often see children who simply wet their pants (isn’t that a symptom of UTI?) who have been treated on multiple occasions with antibiotics for their symptom, but I am convinced they never have had a single UTI. In this case, the symptom is important and burning on urination and wet pants may not be enough for me to think that a true UTI is present. With urgency of urination and lots of bacteria on the urine specimen I might say that the particular patient may have an infection that should be treated. To gain evidence that a UTI might be present I would visually examine the urine under the microscope to look for red blood cells, white blood cells and bacteria… each is most often present with a true UTI. Interpreting the urine culture always has a page 2, and the health care provider need not necessarily dismiss a “mixed flora “ culture as negative. It may be negative, but a physical examination, careful history documenting the types of symptoms, and interpretation of the urinalysis are all necessary to make a final judgement.

    Anything in your urine indicates something a miss..Your urine should be sterile therefore no bacteria, spores, flora would normally be present….

    No. Mixed urogenital flora simply means no bacteria, just the natural-occurring cells that are expected to be found in urine. It’s not a UTI. However, if you have had urinary tract infections in the past, you may be left with cystitis, or inflammation of the bladder lining from said infections but not an active infection. You may require a short-term overactive bladder-type medication from your care provider to help the lining heal and to curb the symptoms from it. Please increase your fluid intake and avoid bladder irritants like caffeine, alcohol, spicy foods, carbonation, and pepper in your diet to help until you can be seen by a care provider for evaluation.

    You don’t. Your body is loaded with flora; most of it is there to maintain a healthy body. If your doctor ordered a urinalysis and culture because you have symptoms of a UTI, the test is negative unless your culture shows >100K organisms like E.Coli or another similar pathogen. If you’re having symptoms like dysuria, push fluids. Talk to your doctor about a course of pyridium. It’s an OTC that reduces bladder inflammation. It will make your pee orange! If you’re diabetic, take good care of yourself. If symptoms persist, see a urologist.

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