EFLM Updates European Urinalysis Guideline with New Performance Standards
The 2023 EFLM guideline comprehensively updates recommendations for urinalysis and urine bacterial culture across European laboratories. Key changes include recommending dual albumin and alpha-1-microglobulin measurement for kidney disease screening, performance specifications for strip tests, chromogenic agar as primary culture medium, and MALDI-TOF MS for rapid uropathogen identification. The guideline also adds three new species to the recognized uropathogen list and provides a reference procedure for urine cultures.
The original study
The EFLM European Urinalysis Guideline 2023.
- Authors
- Kouri TT, Hofmann W, Falbo R, Oyaert M, Schubert S, Gertsen JB, et al.
- Journal
- Clinical chemistry and laboratory medicine
- Type
- Journal Article, Practice Guideline
- PMID
- 38534005
Original abstract
BACKGROUND: The EFLM Task and Finish Group Urinalysis has updated the ECLM European Urinalysis Guidelines (2000) on urinalysis and urine bacterial culture, to improve accuracy of these examinations in European clinical laboratories, and to support diagnostic industry to develop new technologies. RECOMMENDATIONS: Graded recommendations were built in the following areas. MEDICAL NEEDS AND TEST REQUISITION: Strategies of urine testing are described to patients with complicated or uncomplicated urinary tract infection (UTI), and high or low-risk to kidney disease. SPECIMEN COLLECTION: Patient preparation, and urine collection are supported with two quality indicators: contamination rate (cultures), and density of urine (chemistry, particles). CHEMISTRY: Measurements of both urine albumin and α1-microglobulin are recommended for sensitive detection of kidney disease in high-risk patients. Performance specifications are given for urine protein measurements and quality control of multiproperty strip tests. PARTICLES: Procedures for microscopy are reviewed for diagnostic urine particles, including urine bacteria. Technologies in automated particle counting and visual microscopy are updated with advice how to verify new instruments with the reference microscopy. BACTERIOLOGY: Chromogenic agar is recommended as primary medium in urine cultures. Limits of significant growth are reviewed, with an optimised workflow for routine specimens, using leukocyturia to reduce less important antimicrobial susceptibility testing. Automation in bacteriology is encouraged to shorten turn-around times. Matrix assisted laser desorption ionization time-of-flight mass spectrometry is applicable for rapid identification of uropathogens. Aerococcus urinae, A. sanguinicola and Actinotignum schaalii are taken into the list of uropathogens. A reference examination procedure was developed for urine bacterial cultures.