Urine Specimen Recollection Guidelines

Indications for Recollection

A "positive" culture result from a specimen collected in a urine bag cannot be used to document a Urinary Tract Infection (UTI); confirmation requires culture of a specimen collected through catheterization or suprapubic aspiration (SPA) 1
For pediatric patients, bag specimens showing positive results require recollection via catheterization or SPA for confirmation 2
Specimens collected using improper technique (inadequate cleansing, incorrect midstream collection) may need recollection 3
Urine specimens should be recollected if they have been held at room temperature for more than 1 hour without processing 4, 5
Specimens not refrigerated or preserved with boric acid when transport is delayed beyond 1 hour should be recollected 6
Urine must be fresh (within 1 hour after voiding with maintenance at room temperature or 4 hours after voiding with refrigeration) to ensure sensitivity and specificity of urinalysis 1
Mixed bacterial flora or growth of multiple organisms (>2 species) indicates contamination and necessitates recollection 7
When initial urinalysis suggests infection but culture results are inconclusive or inconsistent with clinical presentation 1
When pyuria is present without bacteriuria or vice versa in symptomatic patients 2

For women, midstream collection with cleansing is recommended to minimize contamination 7
For men, midstream collection with cleansing is recommended; first-void urine collection is not recommended due to higher contamination rates 3
A single catheterized urine specimen with one bacterial species yielding ≥10² CFU/mL is sufficient for diagnosis in adults 8
For infants and children, catheterization or SPA is preferred over bag collection when UTI is suspected 1

If transport will be delayed >1 hour, refrigerate the specimen 4, 5
Alternatively, use a urine preservative device containing boric acid for transport to remote laboratories 5
Specimens must be transported to the laboratory in a timely fashion to limit bacterial growth 8

Collecting urine from drainage bags rather than directly from the catheter port 5
Failure to properly cleanse the perineum before collection, especially in children 1
Relying solely on urinalysis without culture for diagnosis of UTI 1