A New Gold Rush: A Review of Current and Developing Diagnostic Tools for Urinary Tract Infections

Xu, Raymond; Deebel, Nicholas A.; Casals, Randy; Dutta, Rahul; Mirzazadeh, Majid

doi:10.3390/diagnostics11030479

Cited by 45 publications

(37 citation statements)

References 71 publications

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“…This approach has changed with the start of the Human Microbiome Project, the first large-scale mapping of the human microbiome using culture-independent methods. Standard urine cultures detect aerobic and fast-growing bacteria, while slow-growing anaerobic microorganisms or bacteria that require different growth conditions remain undetected [ 12 , 13 ].…”

Section: The Urobiome Investigationmentioning

confidence: 99%

“…Relatively recently, due to advances in bacterial assessment, it has been shown that the bladder is not a sterile environment [ 12 ]. In particular, new diagnostic techniques such as PCR, expanded quantitative urine culture (EQUC), whole-genome sequencing (WGS), and next-generation sequencing (NGS) including 16S ribosomal RNA gene sequencing allowed the discovery of uncultured microorganisms and revealed the existence of a urinary microbiome [ 12 , 13 , 14 ].…”

Section: The Urobiome Investigationmentioning

confidence: 99%

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Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

Kawalec

Zwołińska

2022

IJMS

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The microbiome of the urinary tract plays a significant role in maintaining health through the impact on bladder homeostasis. Urobiome is of great importance in maintaining the urothelial integrity and preventing urinary tract infection (UTI), as well as promoting local immune function. Dysbiosis in this area has been linked to an increased risk of UTIs, nephrolithiasis, and dysfunction of the lower urinary tract. However, the number of studies in the pediatric population is limited, thus the characteristic of the urobiome in children, its role in a child’s health, and pediatric urologic diseases are not completely understood. This review aims to characterize the healthy urobiome in children, the role of dysbiosis in urinary tract infection, and to summarize the strategies to modification and reshape disease-prone microbiomes in pediatric patients with recurrent urinary tract infections.

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Section: The Urobiome Investigationmentioning

confidence: 99%

Section: The Urobiome Investigationmentioning

confidence: 99%

Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

Kawalec

Zwołińska

2022

IJMS

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“…With a 95% sensitivity and 85% specificity at growth thresholds as low as 10 2 CFU/mL, the standard urine culture with sensitivity has been the clinician gold standard for diagnosing UTIs [91]. Although a clinically validated diagnostic tool, standard urine culture with sensitivity is not without its limitations.…”

Section: Diagnostic Strategies For Urinary Tract Infections In Develo...mentioning

confidence: 99%

“…Although a clinically validated diagnostic tool, standard urine culture with sensitivity is not without its limitations. The current process takes 48 to 72 h to receive organism identification with associated susceptibility data, allowing for a longer than necessary course of a potentially ineffective or overly broad agent [22,91,92]. Additionally, there has been controversy over the growth threshold to define a clinically significant and positive urine culture.…”

Section: Diagnostic Strategies For Urinary Tract Infections In Develo...mentioning

confidence: 99%

“…Additionally, there has been controversy over the growth threshold to define a clinically significant and positive urine culture. It is debated that the traditional threshold of > 10 5 CFU/mL is too high and will result in a missed UTI diagnosis as 25 to 40% of women with symptoms consistent with a UTI will present with a negative urine culture at this threshold [91,92]. Moreover, while standard urine culture techniques can reliably identify E. coli, they struggle to detect other uropathogens such as Enterococci and Group B streptococci with positive predictive values of 10 and 33%, respectively [92].…”

Section: Diagnostic Strategies For Urinary Tract Infections In Develo...mentioning

confidence: 99%

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Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections

Morado

Wong

2022

Antibiotics

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A urinary tract infection is amongst the most common bacterial infections in the community and hospital setting and accounts for an estimated 1.6 to 2.14 billion in national healthcare expenditure. Despite its financial impact, the diagnosis is challenging with urine cultures and antibiotics often inappropriately ordered for non-specific symptoms or asymptomatic bacteriuria. In an attempt to limit unnecessary laboratory testing and antibiotic overutilization, several diagnostic stewardship initiatives have been described in the literature. We conducted a systematic review with a focus on the application of molecular and microbiological diagnostics, clinical decision support, and implementation of diagnostic stewardship initiatives for urinary tract infections. The most successful strategies utilized a bundled, multidisciplinary, and multimodal approach involving nursing and physician education and feedback, indication requirements for urine culture orders, reflex urine culture programs, cascade reporting, and urinary antibiograms. Implementation of antibiotic stewardship initiatives across the various phases of laboratory testing (i.e., pre-analytic, analytic, post-analytic) can effectively decrease the rate of inappropriate ordering of urine cultures and antibiotic prescribing in patients with clinically ambiguous symptoms that are unlikely to be a urinary tract infection.

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Use of Multiplex Molecular Panels to Diagnose Urinary Tract Infection in Older Adults

Hatfield,

Kabbani,

See

et al. 2024

JAMA Netw Open

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ImportanceMultiplex molecular syndromic panels for diagnosis of urinary tract infection (UTI) lack clinical data supporting their use in routine clinical care. They also have the potential to exacerbate inappropriate antibiotic prescribing.ObjectiveTo describe the frequency of unspecified multiplex testing in administrative claims with a primary diagnosis of UTI in the Medicare population over time, to assess costs, and to characterize the health care professionals (eg, clinicians, laboratories, physician assistants, and nurse practitioners) and patient populations using these tests.Design, Setting, and ParticipantsThis cohort study used Centers for Medicare &amp; Medicaid Services (CMS) claims data for Medicare beneficiaries. The study included older community-dwelling adults and nursing home residents with fee-for-service Medicare Part A and Part B benefits from January 1, 2016, to December 31, 2023.Main Outcomes and MeasuresMultiplex syndromic panels were identified using carrier claims (ie, claims for clinician office or laboratory services). The annual rate of claims was measured for multiplex syndromic panels with a primary diagnosis of UTI per 10 000 eligible Medicare beneficiaries. The performing and referring specialties of health care professionals listed on claims of interest and the proportion of claims that occurred among beneficiaries residing in a nursing home were described.ResultsBetween 31 110 656 and 36 175 559 Medicare beneficiaries with fee-for-service coverage annually (2016-2023) were included in this study. In this period, 1 679 328 claims for UTI multiplex testing were identified. The median age of beneficiaries was 77 (IQR, 70-84) years; 34% of claims were from male beneficiaries and 66% were from female beneficiaries. From 2016 to 2023, the observed rate of UTI multiplex testing increased from 2.4 to 148.1 claims per 10 000 fee-for-service beneficiaries annually, and the proportion of claims that occurred among beneficiaries residing in a nursing home ranged from 1% in 2016 to 12% in 2020. In addition to laboratories or pathologists, urology was the most common clinician specialty conducting this testing. The CMS-assigned referring clinician specialty was most frequently urology or advanced practice clinician for claims among community-dwelling beneficiaries compared with internal medicine or family medicine for claims among nursing home residents. In 2023, the median cost of a multiplex test in the US was $585 (IQR, $516-$695 for Q1-Q3), which was more than 70 times higher than the median cost of $8 for a urine culture (IQR, $8-$16 for Q1-Q3).Conclusions and RelevanceThis cohort study of Medicare beneficiaries with fee-for-service coverage from 2016 to 2023 found increasing use of emerging multiplex testing for UTI coupled with high costs to the Medicare program. Monitoring and research are needed to determine the effects of multiplex testing on antimicrobial use and whether there are clinical situations in which this testing may benefit patients.

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A New Gold Rush: A Review of Current and Developing Diagnostic Tools for Urinary Tract Infections

Cited by 45 publications

References 71 publications

Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections

Use of Multiplex Molecular Panels to Diagnose Urinary Tract Infection in Older Adults

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