Urine-Blood Culture Concordance in Suspected Urosepsis and Implications for Early Clinical Decision-Making
In brief
Urine cultures match blood cultures in 55% of urosepsis, arrive a day sooner
In a review of 2,572 adult urosepsis episodes, urine and blood cultures shared the same pathogen in 55% of cases, and urine results were available within one day for half of the patients. When concordant, urine susceptibility testing closely mirrored blood results and was linked to quicker inflammation decline and improved survival, suggesting urine culture can guide early therapy while blood results await.
- Journal
- International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Q1)
- Published
- 3 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Philipp Grubwieser, Silke Huber, Angelika Bauer, Wolfram Mayr, Werner O Hackl, Cornelia Lass-Flörl, et al.
- PMID
- 42692186
- DOI
- 10.1016/j.ijid.2026.109092
Why clinicians should know about it
- Picked for Microbiology (medical) (paper of the day, 9 September 2026): Urine vs blood culture concordance in urosepsis
Abstract
OBJECTIVES: To assess microbiological concordance, antimicrobial susceptibility testing (AST) agreement, and associated clinical characteristics of suspected urosepsis episodes using paired urine (UC) and blood cultures (BC). METHODS: We retrospectively analyzed 2,572 paired UC-BC episodes from 2,302 adults at a tertiary-care laboratory (2018-2024). Episodes were considered concordant when UC and BC shared at least one identical pathogen. We compared pathogen spectra, culture dynamics, AST results, laboratory referral information, inflammatory markers, and survival. Multivariable logistic regression was used to identify factors associated with concordance. RESULTS: Of 2,572 episodes, 1,405 (54.6%) were concordant. UC reports were finalized earlier than BC reports, with 50.4% available within one day. Concordant episodes showed shorter BC time-to-positivity than discordant episodes (7.8h vs 14.1h). Documented clinical suspicion and detection of Escherichia coli or Staphylococcus aureus in UC were associated with concordance. Among concordant Enterobacterales episodes, UC AST showed high agreement with BC AST. In exploratory analyses, concordant episodes were associated with faster decline of inflammatory markers and better survival. CONCLUSIONS: In suspected urosepsis, UC frequently identified the same pathogen as BC while providing earlier microbiological and susceptibility information. These findings support the potential early diagnostic and antimicrobial stewardship value of UC while BC results remain pending.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.