This kind of bacteriology report is common when the collection wasn’t a mid-stream sample after three swabs of the finger-separated vulva in women. If the woman is symptomatic, and a clean mid-stream culture is difficult to obtain, I think it’s reasonable to do a catheter specimen culture. A mid-stream culture is easier to collect in men, and symptomatic men should be treated. When patients are asymptomatic and there’s a logical explanation for the mixed report, like collection from an ileal loop or the presence of bladder stone or bladder diverticulum, I try to hold off antibiotics until necessary, i.e. unless confronted with fever, chills, pain and hematuria. Treatment should be for a short time — a week or two.

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