Who knew such a familiar infection could be so complicated? Although urinary tract infections (UTIs) are common, especially in women, they are also one of the most frequent causes of sepsis in hospital settings [1]. As we’ve shared previously, these common infections of the urinary tract can affect the kidneys, bladder or urethra, leaving patients vulnerable to serious complications. Some UTIs can be managed through outpatient care, while other infections are complicated and carry higher risks of treatment failure, recurrent infections and even death.
According to the American Urological Association, complicated UTIs are defined as symptomatic cases “associated with factors that increase colonization and decrease the efficacy of therapy,” such as a patient being immunocompromised [2]. UTIs occurring in pregnant women, post-menopausal women and men are generally considered complicated. Each year, complicated UTIs result in more than 626,000 hospitalizations in the U.S. alone, placing an enormous burden on the healthcare system [3].
During a recent presentation at the Association for Molecular Pathology’s 2022 Annual Meeting & Expo (AMP 2022), Dr. Mohit Mathur, M.D., Ph.D., Chief Medical Officer at Pathnostics, discussed the drawbacks of traditional UTI testing for complicated UTIs and the need for rapid, accurate diagnostics. “In the correct patient population, there is a major need for better diagnostics. A need to reduce empiric therapy which is driving antibiotic resistance,” said Dr. Mathur.
What standard urine culture gets wrong
According to Dr. Mathur, the standard urine culture (SUC) – which has long been the industry standard for diagnosing UTIs – presents “significant” shortcomings. Limited sensitivity, a long turnaround time, E. Coli centricity and an inability to grow polymicrobial infections all contribute to the SUC being a less than ideal diagnostic tool, particularly when compared to other testing methods like PCR. “Culture takes time and sometimes you don’t have that time,” said Dr. Mathur. With a three- to five-day wait, long turnaround times for SUC can lead to doctors prescribing antibiotics before they receive a result.
“Many presumptive UTI cases that come in with all the signs and symptoms of UTIs come back either negative or sometimes they come back [with] mixed flora contamination,” said Dr. Mathur. This places clinicians in a bind as they may know it’s a UTI based on the patient’s symptoms, but now they lack a proper diagnosis. A “mixed flora” or “contaminated” report out occurs when more than two or three organisms are cultured, meaning polymicrobial infections cannot be accounted for with the SUC. Similarly, the presence of E. coli can mask the growth of other organisms with SUC.
During his presentation, Dr. Mathur also shared results from a Loyola University study that compared the urobiomes of women with and without symptoms of UTI. The study found that SUC missed two out of three positive patients. Due to the way SUC is formulated, explained Dr. Mathur, it’s not able to detect all bacteria that could be present.
Personalized UTI testing can fill the gap
Since beginning his work with Pathnostics, Dr. Mathur shared that he’s noticed a growing interest in PCR testing across the country for multiple disease states – not just COVID-19. For more difficult UTI cases, some clinicians have already started to employ advanced technologies like PCR.
Dr. Mathur also detailed the unique work his company is doing to provide personalized testing that gathers both genotypic and phenotypic information using PCR and Pooled Antibiotic Susceptibility Testing (P-AST™). According to Dr. Mathur, this allows for the rapid identification of bacteria and yeast associated with UTI but also helps clinicians discover what antibiotics will work best to treat a patient’s UTI. Overall, this technology can better address polymicrobial infections which occur in up to 52% of UTIs, while also promoting antibiotic stewardship.
When met with these difficult-to-manage cases, personalized testing can help where traditional testing and therapeutics have failed. According to Dr. Mathur, more personalized, advanced testing alternatives can account for bacteria interactions which can change antibiotic susceptibility across 19 antibiotics.
“If you’re talking to a urologist or a urogynecologist, the vast majority of the phone calls they get are about UTIs because they see them so frequently, they have so many recurrent cases, it is drowning out their ability to manage other diseases,” said Dr. Mathur. To improve patient outcomes, lower hospitalizations and reduce the burden on clinicians and the healthcare system, more advanced diagnostic technologies are needed.
For more on complicated UTIs and the urgent need for rapid, accurate diagnostics, watch Dr. Mathur’s AMP 2022 presentation on-demand.
For information on Thermo Fisher Scientific solutions that facilitate research in UTIs, please click here.
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