Evidence against the practicality and cost-effectiveness of a gram-positive coccal selective plate for routine urine cultures.

A total of 899 urine cultures were evaluated to assess the need for and cost-effectiveness of using a gram-positive coccal selective plate in the initial plating of urine cultures. Of these cultures, 437 were examined retrospectively and 462 were examined prospectively. Urines were quantitatively plated to three media: sheep blood sugar, MacConkey agar, and phenyl ethyl alcohol agar. Of all urine samples in both studies, 52% yielded no growth on any of the three media. Of all 899 urine cultures, there were only 5 cultures (less than 1%) in which a significant count of a gram-positive organism was detected only on the phenyl ethyl alcohol agar plate and not recoverable on the sheep blood agar plate. In each of these five instances, the need for the use of the selective plate occurred when a Proteus mirabilis strain swarmed over an enterococcus. The inclusion of a selective gram-positive coccal medium for initial plating of urine cultures is unnecessary and not cost-effective. When Proteus swarms on sheep blood agar, a sweep should be made with an inoculating loop from the sheep blood agar and streaked to phenyl ethyl alcohol agar or a similar gram-positive coccal selective medium.