European guidelines for urinalysis : a collaborative document produced by european clinical microbiologists and clinical chemists under ECLM in collaboration with ESCMID

8 February 2001Urinalysis is one of the most common examinations in micro-biological and chemical laboratories as well as at points of care.In addition to bacterial cultures, the term urinalysis encom-passesheremostcommonchemicaltestsrelatedtodiseasesoftheurinary tract and urine particle counting (urine microscopy).Severalexistingdocumentscanbeconsultedfordetailsonthemicrobiological examination of urine [1–6]. While quite a fewnational guidelines covering aspects of urinalysis have also beenpublished [7–9], there is no general international standard orconsensus document applicable for, for example, accreditationor validation of new technology available.Recently, a group chaired by Dr Timo Kouri, Tampere,Finland published the European Guidelines for Urinalysis [10]under the auspices of the European Confederation of Labora-tory Medicine (ECLM). The complete text of this supplementis available in electronic form from Taylor & Francis at http://www.tandf.no/sjcli. These guidelines were prepared togetherwith the European Society of Clinical Microbiology andInfectious Diseases (ESCMID) Working Party on Urinalysis,moderated by Dr Vanya Gant, London, UK, to guarantee thequalityof thewritten guidelines from the microbiological pointofview.SeveralexpertsfrommostEuropeancountrieshavealsocontributed to the review of the draft document. An introduc-tion to the project and the recently published paper for clinicalchemists is given elsewhere [11]. This paper aims to introducethe guidelines to European clinical microbiologists.The ECLM European Urinalysis Guidelines discuss thecomplete process of clinical urine analysis. They embrace indi-cations for urinalysis at several stages: diagnostic strategies;patientpreparation;specimencollectionandtransport;measure-mentproceduresforchemical,morphologicandmicrobiologicalanalyses; quality assurance; and transmission of information, i.e.requests and reports.A stepwise strategy for microbiological urinalysis is alsopresented (Figure 1).Diagnostic schemes are outlined for symptomatic low-riskpatients, symptomatic high-risk patients, and asymptomaticbacteriuria, respectively. Acutely ill patients need an examina-tion with high specificity to reliably demonstrate the presenceof bacteria to support an immediate treatment decision, whilethe rest of the cases can await results from bacterial cultures.A high-performance, high-throughput screening procedurewith low false-negative rates would identify true negatives andallow significant reduction in costly and unnecessary urineculture.Theguidelinessupplydetailedinstructionsfor thecollection,preservation and transport of specimens obtained from eachpatient category, to include patients with indwelling cathetersand children. Practical and useful illustrations on specimencollection are presented and offered for implementation atthe end of the book (also seen in the website of the projectat Tampere University Hospital (http://www.pshp.fi/labnet/EUgroup.htm)). Collection containers, preservation and trans-port are also discussed.Detailed methods are presented in four appendices. Theauthors have chosen to classify diagnostic measurement proce-dures (methods) hierarchically into four levels of performancebased on accuracy of measurement: level 1, rapid proceduressuch as dipsticks with ordinal scale reporting; level 2, routine(quantitative) procedures in common clinical laboratory use;level 3, qualified comparison procedures; and level 4, primaryreference measurement procedures (previously referred to as‘definitive methods’) that are designed to give the true value ofthemeasurand(analyzedcomponent).Inmicrobiology,nosuchprimary procedures are available.