Mycobacterium – Urine
Submission and Collection Notes
Use the Tuberculosis kit to submit specimens collected aseptically.
Specimens in fixative, 24 hour pooled specimens, urine from a catheter bag, specimens <40.0 ml (unless a larger volume is not obtainable), will not be tested.
Urine may be collected from the following:
- Catheter or midstream urine of the first morning specimen. Organisms accumulate in the bladder overnight, therefore first morning void provides the best yield. Only one urine sample a day will be processed for TB
- Suprapubic tap can be collected in the Tuberculosis Kit or in a syringe with needle removed and Luer Lock cap in place.
Indicate on the General Test Requisition Form if the patient has been treated with bladder instillation of M. bovis BCG.
Refer to Additional Mycobacterium Collection Information for detailed collection instructions.
Timing of Specimen Collection
Collect first morning specimen on 3 consecutive days.
Swabs are not recommended for the isolation of mycobacteria since they provide limited material and the bacteria adsorb onto the swab material which may contain toxic substances. Negative results obtained from specimens submitted on swabs are not reliable.
Frozen specimens may decrease the yield of mycobacteria.
Specimens obtained for initial diagnosis after the initiation of antimicrobial therapy may produce false negative results.
Saprophytic mycobacteria in tap water may produce false-positive culture or slide results.
Delayed transportation of specimens may promote overgrowth by contaminating indigenous microbiota.
Preparation Prior to Transport
Label the specimen container with the patient’s full name, date of collection and one other unique identifier such as the patient’s date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.
Place specimen container in the biohazard bag and seal bag, and insert the completed requisition in the pocket on the outside of the sealed biohazard bag.
Store at 2-8 °C if transport is delayed more than one hour. Specimens should be transferred to the lab ASAP where possible.
Test Frequency and Turnaround Time (TAT)
Mycobacterial cultures are performed daily Monday to Saturday.
Turnaround time is up to 1 day from receipt by PHO laboratory for smear results from the concentrated specimen.
Turnaround time is up to 49 days from receipt by PHO laboratory for negative cultures is 49 days.
A positive culture is reported within 24 hours of growth. Depending on the species and treatment of the patient, a culture may grow within 1 to 2 weeks or take as long as 6-7 weeks.
All new isolates of M. tuberculosis complex are phoned to the submitter within 24 hours of identification.
STAT and Critical Samples Testing
STAT testing is not available.
Contact Public Health Ontario Laboratory to request approval for URGENT testing.
If URGENT testing is approved, mark URGENT on the outside of the package as well as on the requisition. A phone number and contact person must be provided for phoning the result.
URGENT Smears Specimens that are received in the lab by 2:00 p.m. will have a smear done and phoned the same day. Specimens that arrive after 2 p.m. will have the smear result phoned first thing the following morning.
Results are reported to the ordering Medical Officer of Health or physician or health care provider as indicated on the requisition.
Specimens that are positive for Mycobacterium tuberculosis are to be reported to the Medical Officer of Health as per Health Protection and Promotion Act.
A smear, prepared from the concentrate, is stained using the Auramine-Rhodamine (AR) fluorochrome stain and fluorescence microscopy.
A negative AFB smear does not rule out TB, the culture may still be positive.
Specimens are set up for culture on solid and in liquid media and incubated for up to 7 weeks.