Dear Client,

Clinical Pathology Laboratories, Inc. (CPL), is a committed partner in providing effective, appropriate patient care by ensuring that our testing reflects current medical standards and guidelines.

In our review process, we have identified a quality improvement opportunity concerning ordering patterns and specimen requirements for our Unit Code 6089, Urine Culture, Work Up All Organisms. This Unit Code requests urine culture to identify all organisms and perform antibiotic susceptibilities on each significant organism. While we understand that this request may be appropriate for some clinical scenarios and specialties, such as infectious disease or urology practices, we have identified a pattern that suggests some clinics are requesting this Unit Code by default or are routinely using this for evaluation of uncomplicated urinary tract infections. This practice may identify clinically irrelevant organisms and promote the use of clinically inappropriate antibiotic therapy, not conforming to standards of antimicrobial stewardship.

The Microbiology Department at CPL follows guidelines provided by American Society of Microbiology (ASM), Clinical and Laboratory Standards Institute (CLSI), and Infectious Diseases Society of America (IDSA) guidelines for organism identification and susceptibility testing. To promote adherence to these guidelines, CPL will initiate the following steps to ensure that Unit Code 6089, Urine Culture, Work Up All is limited to specimens from the appropriate clinical presentation:

  • Unit Code 6089 will be inactivated by June 1, 2022 with a replacement code that will require physician acknowledgment documentation for use.
  • After June 1, 2022, requests for service using Unit Code 6089 will be fulfilled with Unit Code 6049, Standard Urine Culture.
  • Specimen requirements for the replacement code will include catheterized urine specimens, suprapubic aspirates, cytoscopic specimens, or urine collected from patients with indwelling stents, urinary foreign bodies, clinically infected calculi, complicated UTIs, or post-prostatic massage.  Specimens should be collected and then transferred to a gray-top urine transport tube.

Unit Code 6049, Standard Urine Culture, is appropriate for symptomatic men and women, suspicious for uncomplicated urinary tract infection. The Microbiology department follows CLSI and ASM guidelines to identify urinary pathogens in pure culture or present at a significant level in mixed cultures. Additionally, Group B Streptococcus is identified at any colony count and in any background in women of child bearing age. A final culture result of “normal genital flora” is based on identification of mixtures of Lactobacillus, coagulase negative Staphylococcus or other skin contaminants in the absence of urinary pathogens. For further questions, please contact your account executive. We appreciate your support of Clinical Pathology Laboratories.

Christine Burgess, MD, MPH 
Director, Microbiology