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Colony Count Interpretation Colony Count Interpretation
• If the number of colonies of one colony type is more
• If the calibrated loop than 100,000, then report out colony count as
used was 0.001 ml [Need pic of 15 >100,000 cfu/ml
colonies of E. coli
then each colony on a Mac plate – • Confluent growth of bacteria, covering most of the
equals 1000 cfu colony count] inoculated surface area of the plates can be read as
>100,000 cfu/ml.
– Example:
13 colonies seen x
1000 = 13,000 cfu/ml
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Colony Count Guidelines General Considerations
Result Specimen type / Clinical Workup
condition, if known
>104 cfu/ml of single potential Clean-catch midstream urine / Complete – identification of the
pathogen, or for each of 2
potential pathogens
pyelonephritis, acute cystitis,
asymptomatic bacteriuria;
organism and appropriate
susceptibility testing
• >100,000 cfu/ml is indicative of a UTI,
OR catheterized urine except when the isolate is a
>103 cfu/ml of a single potential Clean-catch midstream urine / Complete – identification of the
pathogen symptomatic males
OR catheterized urine
organism and appropriate
susceptibility testing
contaminant
OR acute urethral syndrome
> 3 organism types with no Clean-catch midstream urine None. Because of possible
predominating organism OR catheterized urine contamination, ask for another
specimen • 10,000 – 100,000 cfu/ml may indicate
Either 2 or 3 organism types Clean-catch midstream urine Complete workup for the
with predominant growth of one predominating organism(s); infection, especially if only one colony
organism type and <104 cfu/ml description of the other
of the other organism types(s) organism(s) type is growing
>100 cfu/ml of any number of Suprapubic aspirates, any other Complete – identification of
organism types (set up with a surgically obtained urines organism and appropriate
0.001 and 0.01 ml calibrated (including ileal conduits, susceptibility testing
loop) cystoscopy specimens)
General Considerations
A urine culture has
• <10,000 cfu/ml is not worked up when
contaminants are present 25,000 cfu/ml of one colony
type. Should this be
• Persistence of the same organism on considered as a potential
repeat urine cultures will increase the
likelihood that it is a pathogen even if the
pathogen or contamination?
colony counts are low A colony count between 10,000 – 100,000 cfu/ml
may indicate infection, especially if only one colony
– i.e. <10,000 cfu/ml type is growing – so need to identify the organism
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Remember! Questions To Ask
• When there is growth of three or more • What is the colony count for each type of
different organisms, consider the colony?
specimen contaminated and work-ups – The number of colonies can aid in
are not done determining if the organism is just
contamination (lower colony count) or a
potential pathogen (higher colony count)
What questions must you ask What are the “Points to keep
when you evaluate a urine in mind” when evaluating a
culture? urine culture?
What media has growth? •Type of urine collection method used.
How many colony types are growing? •Patient clinical history (if available) such as
What is the colony count for each colony type? age, symptoms, and antibiotic therapy.
Is the growth a potential pathogen or contamination?
•Normal periurethral flora (contaminants).
•Colony count guidelines.
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Workup of Significant Growth Workup of Significant Growth
• Any colony type that is suspicious of being • In addition, automated systems can be
a potential pathogen needs to be identified used to identify the organism
• Utilizing the routine procedures for – i.e. MicroScan and Vitek
identification must be followed
– Based on your clinical site procedures • Once organism is identified, again ask:
• Rapid tests such as catalase, oxidase, and – “Is it still considered a pathogen or a
spot indole can be performed contaminant?”
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Documentation of Workup
• Date of observation
For how long are urine • Number of different colony types and
culture media plates kept on what media they are growing
for evaluation? • Colony counts
• Characteristics of each colony type
48 hours
(gram stain, colony morphology)
72 hours for ABAP
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What additional information
How would a urine culture be would you need to know to
reported that has E. coli determine if the following is
(>100,000 cfu/ml) and Staph. significant or contamination on a
epi. (9,000 cfu/ml) growing? urine culture?
E. coli would be considered a pathogen 9,000 cfu/ml of E. coli
so report colony count, identification and Specimen collection method, patient
susceptibility results. Staph epi is a history (if available), and any previous
contaminant so report colony count and
urine culture results.
identification only.
Review References:
• “No growth” versus “Growth” • Mahon, C.R., Lehman, D.C. & Manuselis,
• Colony count G., Textbook of Diagnostic Microbiology,
– Interpretation and guidelines 3rd Ed., Saunders Elsevier, 2007.
• Questions to ask
• Points to keep in mind
• Workup significant growth
• Documentation and reporting results