The updated topics of the EFLM European Urinalysis Guideline 2023

Background: The ECLM European Urinalysis Guideline on laboratory procedures in urinalysis and urine bacterial culture were published in 2000. It has now been updated by the EFLM Task and Finish Group Urinalysis. A shared single-voided specimen again reinforced co-operation between professionals in clinical chemistry and clinical microbiology to produce a shared guideline both for laboratories and for diagnostic industry in the field.
Recommendations: Graded recommendations were built in the following areas:
Medical needs and test requisition: Strategies of urine testing were described to patients with low and high-risk to urinary tract infection (UTI) or kidney disease.
Specimen collection: Patient preparation, and urine collection are now 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 renal disease in high-risk patients. Performance specifications for urine protein measurements and quality control of multiproperty strip tests were given.
Particles: Procedures for microscopy were reviewed for diagnostic urine particles, including urine bacteria. Technologies in automated particle counting were updated with advice how to verify new instruments with the reference microscopy.
Bacteriology: Chromogenic agar was recommended as primary medium in urine cultures. Limits of significant growth were 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 were taken into the list of uropathogens. Moreover, a reference examination procedure was developed for urine bacterial cultures.
Guideline status: The draft of the EFLM European Urinalysis guideline has been submitted to the Executive Board of the EFLM, and parallelly to the Guidelines Subcommittee of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).