PEARL –  collect culture before starting antibiotics due to wide range of pathogens and increased likelihood of resistance with CA-UTI

Always collect a urine culture and sensitivity (C/S) when suspected CA-UTI

The collection of a sample is an ideal time to assess if a urinary catheter is still required because removing the catheter is the best way to prevent CA-UTI (IDSA 2009 CA-UTI guidelines).

If catheter is still required:

Placed <2 weeks: the decision to obtain from sampling port vs placing a new catheter should be made on a case-by-case basis viewing the risks and benefits
Placed >2 weeks: replace catheter first and then obtain urine specimen
The 2-week (JAMDA – Collecting Urine) cut off threshold is somewhat arbitrary

If catheter not required:
Obtain a midstream/clean catch urine specimen.
If unable get midstream/clean catch due to mentation
Men: consider a condom catheter for 30 – 120 minutes or in and out catheterization
Women: Consider in and out catheterization

BONUS PEARL –  The absence of epithelial cells suggests a good, uncontaminated sample. In men, it is recommended to clean the urethral meatus before collection.