{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:37:27Z","timestamp":1786541847554,"version":"build-2736575974"},"reference-count":15,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2026,8,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n \n \n Artificial intelligence-based culture reading tools can potentially accelerate reading, improving reporting consistency in image-based interpretation, which is relevant for high-volume urine cultures. This study evaluated the BD Kiestra Urine Culture Application (UCA) in a centralized microbiology laboratory. Consecutive midstream and indwelling catheter urine specimens inoculated onto BD BBL CHROMagar Orientation were analyzed by the UCA. Growth score output at different reporting thresholds was evaluated, along with expert rule-based categories constructed using the app\u2019s growth score, purity score, and presumptive identification parameters, with blinded technologist image reads as the comparator. Of 1,304 cultures, 1,251 were evaluable for growth score comparison, and 1,239 for expert-rule assessment. The exact agreement across four growth categories (<10\n 5<\/jats:sup>\n , 10\n 5<\/jats:sup>\n , 10\n 6<\/jats:sup>\n , \u226510\n 7<\/jats:sup>\n CFU\/L) was 86.2%. Using a <10\n 6<\/jats:sup>\n CFU\/L triage threshold, the overall agreement was 95.9%, with positive and negative percent agreement of 89.9% and 98.9%, respectively. In this dataset, 30.5% of cultures met this threshold for potential auto-release or batch-review. For presumptive identification in \u226510\n 7<\/jats:sup>\n CFU\/L pure or predominant cultures, UCA performed best for\n E. coli<\/jats:italic>\n (PPA 98.9%). For\n Enterococcus<\/jats:italic>\n spp., PPA was 89.5%, but PPV was low (25.4%), reflecting frequent false-positive presumptive calls. UCA performed well at clinically relevant thresholds and could meaningfully reduce the burden of manual reading. Most discrepancies reflected differences between total colony count outputs and morphotype-based laboratory quantitation conventions, along with missed subtle growth. Expert-rule category discrepancies were primarily related to differences in purity output and presumptive identification, particularly fine light-blue growth being called presumptive\n Enterococcus<\/jats:italic>\n spp., highlighting a priority area for improvement.\n <\/jats:p>\n \n IMPORTANCE<\/jats:title>\n \n Urine cultures are among the most frequently ordered culture tests in clinical microbiology. Timely, consistent plate interpretation impacts both patient care and laboratory capacity. Digital imaging of culture plates facilitates the application of artificial intelligence to urine culture specimens, but laboratories need clear evidence of where these tools perform reliably and where their outputs require caution. This study shows how an automated urine culture reading application can support safe triage of cultures with little or no growth, helping technologists focus on specimens that likely require workup and clinical action. At the same time, it highlights an important limitation: organism labeling can be vulnerable to look-alike growth patterns. In our dataset, fine or hazy, light-blue growth that was not typical of\n Enterococcus<\/jats:italic>\n spp. was classified by the application as presumptive\n Enterococcus<\/jats:italic>\n spp., a mismatch that could affect downstream decisions if not recognized. These findings reinforce that local validation and human oversight remain essential, even for common uropathogens, such as\n Escherichia coli<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:sec>\n <\/jats:sec>","DOI":"10.1128\/jcm.00270-26","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:00:21Z","timestamp":1782100821000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the BD urine culture application for artificial intelligence-assisted urine culture interpretation"],"prefix":"10.1128","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6927-3395","authenticated-orcid":true,"given":"Petrus","family":"van der Walt","sequence":"first","affiliation":[{"name":"Alberta Precision Laboratories","place":["Edmonton, Canada"]},{"id":[{"id":"https:\/\/ror.org\/0160cpw27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine and Pathology, University of Alberta","place":["Edmonton, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-098X","authenticated-orcid":false,"given":"Prenilla","family":"Naidu","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories","place":["Edmonton, Canada"]},{"id":[{"id":"https:\/\/ror.org\/0160cpw27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine and Pathology, University of Alberta","place":["Edmonton, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Avoledo","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories","place":["Edmonton, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Mak","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories","place":["Edmonton, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3757-0924","authenticated-orcid":false,"given":"Francene","family":"Starko","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories","place":["Edmonton, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2010.190"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1756287219832172"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy1121"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2024.03.004"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00301-13"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01683-19"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01442-22"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.35.11.2773-2777.1997"},{"key":"e_1_3_3_10_2","unstructured":"Becton Dickinson and Company. 2018. BBL(TM) chromagar(TM) orientation medium. Sparks (MD): Becton Dickinson and Company 8011255."},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2021.115567"},{"key":"e_1_3_3_12_2","first-page":"3","volume-title":"Clinical microbiology procedures handbook","author":"Chan WW","year":"2016","unstructured":"ChanWW. 2016. Urine cultures, p 3\u20133. In LeberAL (ed), Clinical microbiology procedures handbook, 4th ed. ASM Press, Washington (DC).","edition":"4"},{"key":"e_1_3_3_13_2","unstructured":"Becton Dickinson (BD) Kiestra B.V. 2020. Kiestra urine culture application user\u2019s manual powered by BD synapsys informatics solution. Drachten (Netherlands) BD Kiestra B.V L012259(01) 2020-12."},{"key":"e_1_3_3_14_2","unstructured":"U.S. Food and Drug Administration. 2007. Statistical guidance on reporting results from studies evaluating diagnostic tests: guidance for industry and FDA staff. Silver Spring MD: U.S Food and Drug Administration"},{"key":"e_1_3_3_15_2","volume-title":"CLSI guideline EP12","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2023","unstructured":"Clinical and Laboratory Standards Institute (CLSI). 2023. Evaluation of qualitative, binary output examination performance. In CLSI guideline EP12, 3rd ed. Clinical and Laboratory Standards Institute, Wayne (PA).","edition":"3"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bj.2017.09.001"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.00270-26","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.00270-26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:03:09Z","timestamp":1786539789000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/jcm.00270-26"}},"subtitle":[],"editor":[{"given":"Jennifer","family":"Dien Bard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,12]]}},"alternative-id":["10.1128\/jcm.00270-26"],"URL":"https:\/\/doi.org\/10.1128\/jcm.00270-26","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"assertion":[{"value":"2026-02-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00270-26"}}