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Evaluation of the Cult-Dip Plusdip Slide Method for Urinary Tract Infection

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Evaluation of the Cult-Dip Plusdip Slide Method for Urinary Tract Infection 7107 Clin Pathol 1995;48:710-713 Evaluation of the Cult-Dip Plus dip slide method for urinary tract infection J Clin Pathol: first published as 10.1136/jcp.48.8.710 on 1 August 1995. Downloaded from J M Blondeau, Y Yaschuk, D Galenzoski, D Hrabok, M Isaacson, L Lee, H Link, L Walshaw Abstract results comparable with those obtained using Aim-To evaluate the Cult-Dip Plus standard plate streaking methods.3'-Dip slides (Merck, Germany), a bacteriological cul- that incorporate substrates for the detection ture test for detecting uropathogens. of bacterial enzymes could result in the early Methods-Cult-Dip Plus consists of Bro- identification of uropathogens. Kilian and lacin (CLED) and MacConkey agar, each Bulow8 showed that E coli was one of the containing methylumbelliferylglucuronide few bacteria to produce the enzyme B-glu- (MUG). Using 1022 urine samples, this curonidase. Hydrolysis of 4-methylumbelliferyl- product was compared with the routine B-D-glucuronide (MUG) by B-glucuronidase method of calibrated loop inoculated produces 4-methylumbelliferon-a product CLED and blood agar for screening urine which fluoresces under ultraviolet light. for uropathogens. The MUG test for Cult-Dip Plus is a new urine dip slide con- identifying Escherichia coli was also eval- sisting of Brolacin (cystine, lactose, electrolyte uated. deficient (CLED)) and MacConkey agar, each Results-Compared with the routine containing MUG. We evaluated the Cult-Dip method, Cult-Dip Plus has a sensitivity, Plus for recovery of uropathogens and the specificity, positive predictive value and MUG test for rapid identification of E coli. negative predictive value of 88-3%, 98-0%, 91.90b, and 97*1%, respectively. The MUG test correctly identified 92% of E coli isol- Methods ates with a sensitivity, specificity and pos- The MUG test is based on detection of fluor- itive predictive value of91-6%, 95-2%, and escence from release of 4-methylumbelliferon 93-6%, respectively. following hydrolysis of the parent compound Conclusion-Cult-Dip Plus appears to be by B-glucuronidase. Cult-Dip Plus was sup- an alternative method to the calibrate loop plied by BDH (Toronto, Ontario, Canada). The method for detecting uropathogens. Blood and CLED agars were purchased from http://jcp.bmj.com/ MUG test permits rapid, reliable and in- PML Microbiologicals (Edmonton, Alberta, expensive identification of E coli. Canada). (J Clin Pathol 1995;48:710-713) We prospectively analysed 1022 urine samples from different patients submitted over Keywords: Dip slide, urinary tract infection, E coli. a two month period. The semiquantitative plate culture method described by Clarridge et al9 was used as the reference method for de- on October 1, 2021 by guest. Protected copyright. Acute urinary tract infections are a major health termining bacteriuria. For routine culture, problem affecting an estimated 10-20% of 0001 ml urine was delivered to each blood women at some point during their lifetime.' In and CLED agar plate using a calibrated dis- healthy men the prevalence of urinary tract posable loop (Simport, Quebec, Canada). This Division of method detects . 1000 colony forming units/ Microbiology, St infections is less than 0-1%. As many as 42% Paul's (Grey Nuns) of all hospital acquired infections are of the ml (cfu/ml). Hospital, 1702 20th urinary tract.2 Following this, the Cult-Dip Plus dip slide Street West, was inoculated by either immersing the slide Saskatoon, In both compromised and uncompromised Saskatchewan, Canada hosts Escherichia coliis the micro-organism most in the urine (minimum 30 ml required) or when S7M OZ9 commonly associated with urinary tract in- the volume of urine was such that the paddle J M Blondeau could not be immersed, by flooding both sides Y Yaschuk fections. Others, such as Staphylococcus sp, D Galenzoski Enterococcus sp, Pseudomonas sp, and other spe- of the slide with urine using a sterile disposable D Hrabok cies belonging to the Enterobacteriaceae are also pasteur pipette (5 ml). This method detects M Isaacson significant causes of urinary tract infections; 100 cfu/ml. Colony counts of 1-10 colonies L Lee Plus were considered H Link however, their prevalence may vary depending detected by Cult-Dip L Walshaw on the age and condition of the host. Isolation negative so as to standardise the colony count and rapid identification of micro-organisms comparisons between both methods. After in- Department of oculation, culture plates/dip slides were in- Microbiology, causing urinary tract infections is important University of for determining the causative organism and cubated for 18-24 hours at 35-37°C. Saskatchewan, because it affects the appropriate selection or Saskatoon J M Blondeau continuation, or both, ofantimicrobial therapy. Urine dip slides are immersible plastic IDENTIFICATION OF MICRO-ORGANISMS Correspondence to: on lactose colonies Dr J M Blondeau. paddles containing agar medium each side. Typical fermenting resembling been shown to be E coli were identified by using the Bactident E Accepted for publication Dip slides have previously 20 December 1994 cost-effective, easy to use devices that provide coli test (BDH, Toronto, Ontario, Canada), a Evaluation of the Cult-Dip Plus dip slide method for urinary tract infection 711 Table 1 Comparison of 1022 uine specimens isolated by Cult-Dip Plus and routine Compared with the calibrated loop method culture Cult-Dip Plus had a sensitivity of 88-3%, a Both methods Cult-Dip Plus Routine culture specificity of 98-0%, a positive predictive value J Clin Pathol: first published as 10.1136/jcp.48.8.710 on 1 August 1995. Downloaded from Negative' 761 24 16 of 91-9%, and a negative predictive value of Positive* 181 16 24 97'1% (table 1). * Pure isolates in quantities greater than 10 000 cfu/ml. There were 221 significant organisms iden- + Includes those with no visible growth and those with two or more species of micro-organism tified. Table 2 shows the frequency of uro- (mixed). pathogens detected by either Cult-Dip Plus, routine culture or both. As expected, E coli was the most frequently recovered pathogen. In Table 2 Frequency of uropathogens isolated by Cult-Dip Plus and routine culture all cases where a significant uropathogen was Micro-organism Both methods Cult-Dip Plus Routine method recovered by either Cult-Dip Plus or by routine Gram negative bacilli 131 13 11 culture but not by both, the corresponding Gram positive cocci 38 3 13 method had mixed organisms and was not Yeast 12 - - All genera 181 16 24 investigated further. Table 3 shows the results of the MUG test for identification ofE coli. Of the E coli isolates, 92% were MUG test positive compared with Table 3 Summary of uropathogens MUG test positive by either Cult-Dip Plus, 25% of K pneumoniae and 20% of P mirabilis Bacident, or both isolates recovered by Cult-Dip Plus. None of Cult-Dip Plus Isolates Routine culture the remaining isolates were MUG test positive. (No. positivelno. tested (%)) (No. positivelno. tested (%o)) In total, 105 E coli isolates were recovered Micro-organism Cult-Dip Plus Bactident Bactident as significant uropathogens. Of these, 88 were by both methods, eight by Cult-Dip E coli 88/96 (92) 64/68 (94) 70/77 (91) recovered Kpneumoniae 4/16 (25) NT NT Plus only and nine by routine culture only. Of Pmirabilis 2/10 (20) NT NT the 99 E coli isolates recovered by Cult-Dip NT=not tested. Plus, 96 underwent a MUG test (three were not viewed for fluorescence and were not analysed further) (table 3). Of the 96 tested, 88 (92%) were MUG test positive. Detection of fluor- two hour identification system for E coli based escence was similar for both media on the dip on indole formation and B-D-glucuronidase slide. Thirty one of the 99 isolates recovered (MUG test). If either of these tests were neg- by Cult-Dip Plus were identified by Vitek and ative, isolates were identified by Vitek (bio- 68 were identified by Bactident. Of the 68 Merieux Vitek Inc., Hazelwood, Missouri, isolates tested by Bactident, 64 (94%) were USA). All other significant micro-organisms MUG test positive. Of the eight E coli isolates recovered by either method were identified detected by Cult-Dip Plus only and which by Vitek or by a combination of individual were MUG test negative, five were tested by http://jcp.bmj.com/ biochemical and/or latex agglutination tests. Bactident and three were MUG test positive The dip slide MUG test was read by holding (see discussion). Overall, the Cult-Dip Plus dip slides with significant growth under long MUG test had a sensitivity of 91-6% and a wave ultraviolet light (360 nm). Presumptive specificity of 95-2% and a positive predictive identification of E coli was confirmed by Bac- value of 93-6% for identifying E coli. tident. The presence of fluorescence indicated Of the 95 E coli isolates recovered by routine on October 1, 2021 by guest. Protected copyright. a positive MUG test. Results for isolation of culture, 77 were tested by Bactident and 70 uropathogens and identification ofE coli by our (91%) were MUG test positive (table 3). Of routine method(s) and with the Cult-Dip Plus the 70 MUG test positive isolates, 63 (90%) were compared. were also positive by the Cult-Dip Plus MUG test. Of the seven remaining isolates, five were Cult-Dip Plus MUG test negative and the Results remaining two were untested. Ofthe 19 routine Of the 1022 urine samples analysed, 221 cultures that the Bactident MUG test were not (21 6%) had significant findings (>10 000 cfu/ performed on, 16 were Cult-Dip Plus MUG ml and pure) by one method or the other; 181 test positive and three were not tested.
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