(302) Reducing contamination of midstream voided urine specimens in an obstetric population: a randomized controlled trial

 Screening for asymptomatic bacteriuria in pregnancy has been part of routine prenatal care for decades, as untreated bacteriuria can lead to acute pyelonephritis and adverse pregnancy outcomes, typically complicated via the clean catch midstream urine collection method (CC).  CC can be difficult to obtain and often results in contamination, making interpretation of a urine culture difficult. The Peezy urine collection device (Peezy) has shown promise in reducing contamination rates compared to CC but has not been studied in the pregnant population.  This study aims to compare the rates of contamination in urine cultures collected early in prenatal care between the CC and Peezy urine collection methods.

Study Design: This randomized controlled trial at Loyola University Medical Center enrolled adult, English-speaking pregnant patients < 20-weeks gestation from August 2022 to January 2024. Exclusion criteria were urinary tract anomalies, ongoing antibiotic treatment, or recurrent urinary tract infections. Participants were randomized to either Peezy or CC for urine collection. The primary objective was to compare contamination rates of urine specimens collected using the Peezy versus CC. Logistic regression was used to compare the odds of contamination between Peezy and CC.

Results: 218 patients were included in our analysis.  The contamination rate was not different between the 2 groups; 61.3% (n = 73/119) for CC and 52.5% (n = 52/99) for Peezy, (p = 0.19) There was no difference in rates of contamination between CC and Peezy, regardless of BMI status.  There was no difference in ASB detection rate between CC and Peezy, p >0.05.  Among our patients with contamination of their urine culture, 4% had a repeat sample.

Conclusion:

Overall, the Peezy collection device did not demonstrate a significant advantage over CC in detecting ASB and reducing contamination of screening urine cultures in pregnant patients, and our study indicates that the Peezy device is more difficult to use, resulting in more sample collection failures.