Standard Urine Culture Research Articles

Tarnished gold—the “standard” urine culture: reassessing the characteristics of a criterion standard for detecting urinary microbes

Diagnosis and treatment of urinary tract infections (UTIs) remains stagnant. The presumption that a patient either has a UTI or does not (binary choice) is inappropriately simplistic. Laboratory diagnostic tests have not advanced for decades. The goal of UTI treatment has not been rigorously defined and may increase the prescription of potentially harmful, inappropriate antibiotics. Despite the high incidence of UTI diagnoses, the high cost of UTI treatment, and increasing concerns associated with antimicrobial resistance, the development of novel and more accurate UTI tests has not been considered a priority, in part due to the general perception that current UTI care is already sufficient. In this review, we discuss the importance of improving UTI diagnostic testing to improve treatment outcomes. We discuss the problems associated with UTI diagnosis. Urinary microbes are alive and exist in both healthy and symptomatic individuals—urine is not sterile. We specifically outline the limitations of standard urine culture methods used by clinical microbiology laboratories, explaining clearly why such methods cannot be considered to be the “gold standard,” as standard culture methods underreport most of the urinary tract microbes, including some acknowledged and many emerging uropathogens. We do not recommend abandonment of this test, as no universally accepted substitute yet exists. However, we strongly encourage the development of new and improved diagnostic tests that can both improve outcomes and preserve antibiotic stewardship.

Comparative Study of Standard Urine Culture and Enhanced Urinary Culture Technique for Isolation of Pathogenic Bacteria from Urinary Tract Infection among Women at a Tertiary Care Centre, Rajasthan

Comparative Study of Standard Urine Culture and Enhanced Urinary Culture Technique for Isolation of Pathogenic Bacteria from Urinary Tract Infection among Women at a Tertiary Care Centre, Rajasthan

A test combining multiplex-PCR with pooled antibiotic susceptibility testing has high correlation with expanded urine culture for detection of live bacteria in urine samples of suspected UTI patients

We evaluated whether multiplex polymerase chain reaction (M-PCR) detects viable micro-organisms by comparing micro-organism identification with standard urine culture (SUC) and expanded quantitative urine culture (EQUC). Of the 395 organisms detected by M-PCR, EQUC detected 89.1% (p = 0.10), whereas SUC detected 27.3% (p < 0.0001 vs. M-PCR and p < 0.0001 vs EQUC). M-PCR identified 260 nonfastidious bacteria, EQUC detected 96.5% (p = 0.68), whereas SUC detected 41.5% (p < 0.0001). Common nonfastidious bacteria missed by SUC included Escherichia coli (72.5% detected), Klebsiella pneumoniae (66.7% detected), Enterococcus faecalis (34.6% detected) and Enterococcus faecium (0% detected). M-PCR identified 135 fastidious bacteria and EQUC 101 (74.8%, p = 0.01), whereas SUC failed to detect any (0%, p < 0.0001). Clinical samples evaluated using EQUC and M-PCR yielded very similar findings, indicating that most microbes identified by M-PCR represented viable organisms, and validating M-PCR as a diagnostic tool for UTIs.

Systematic review–how do we identify urinary tract infections today?

Standard urine culture is still considered a gold standard in the identification of Urinary Tract Infections (UTIs), but is time-consuming and in approximately 20% of patients with UTI symptoms produces false-negative results. Medical and scientific communities are in search of a faster, more accurate, yet affordable method with high clinical utility. As a supplement to standard culture in routine practice Urine Flow Cytometer (UFC) screening method is used, in order to detect negative urine culture samples. This allows for shortening issuing time for sterile urine culture reports and the cost of the analysis itself. In addition, urine dipstick tests and microscopic examinations of urine sediment can also be performed in biochemical laboratories but are usually preceded by urine culture. Nowadays, advanced methods such as proteomics and genomics are used to identify pathogens causing UTIs but are still used mainly for scientific purposes and rarely in clinical practice. From genomic methods PCR, 16S rRNA gene sequencing, and metagenome sequencing are being researched. PCR is great for targeted diagnostics, 16S RNA gene amplification can determine bacterial genera and their abundance, but is not good for in-depth species analysis, while metagenomics is the most comprehensive and unbiased method. The proteomics field also offers several methods for microbial identification, with MS as the leading one. Clinical applications of MS platforms usually imply MALDI-TOF MS analyzers which produce a characteristic spectrum called peptide mass fingerprint or more present for scientific purposes LC-MS/MS-based peptide sequencing.

Real-World Evidence That a Novel Diagnostic Combining Molecular Testing With Pooled Antibiotic Susceptibility Testing is Associated With Reduced Infection Severity and Lower Cost Compared With Standard Urine Culture in Patients With Complicated or Persistently Recurrent Urinary Tract Infections

Purpose: Develop real-world evidence that rapid identification of uropathogens and susceptibilities improves urologic outcomes for patients with complicated or history of recurrent urinary tract infections (r/cUTIs). Standard urine culture (SUC) is slow, often missing polymicrobial infections and altered antibiotic resistance from their metabolic interactions. Materials and Methods: We compared 1-year UTI-related health care utilization and costs for UTIs diagnosed by outpatient multiplex polymerase chain reaction/pooled antibiotic susceptibility testing (mPCR/P-AST) vs SUC among Medicare beneficiaries with r/cUTIs, using claims from a deidentified random 5% sample of beneficiaries with an index UTI in 2018 followed by 12 months during which all outpatient UTI tests were either mPCR/P-AST or SUC. Outcomes were compared between 69 individuals diagnosed using mPCR/P-AST and 678 propensity-matched individuals using SUC. Regression models modeled cost differences with 95% confidence intervals (CIs). Results: Of 1,654,548 enrollees in 2018, 11.6%, 0.06%, and 9.6% had claims for UTI, mPCR/P-AST, and SUC, respectively. The matched mPCR/P-AST and SUC cohorts were statistically equivalent at baseline. The mPCR/P-AST cohort was nonsignificantly less likely than the SUC cohort to have a postindex UTI (65.2% vs 72.0%, P = .24). Cost per subsequent UTI was significantly lower for mPCR/P-AST ($767 vs $1,303, P = .0013). Average total 1-year UTI-related cost was $501.85 (95% CI: $79.87, $562.08 P = .004) lower per mPCR/P-AST member vs SUC ($629.55 vs $1131.39). Nonoutpatient treatment accounted for 22.5% of mPCR/P-AST vs 53.4% of SUC UTI-related costs. Conclusions: In patients with r/cUTI, rapid identification of pathogens and antibiotic susceptibilities using mPCR/P-AST is associated with lower UTI-related clinical care and utilization costs compared with SUC.

Potential System Utilization and Cost Savings of Advanced Microbial Testing for Urinary Tract Infections

Management of chronic and complex urinary tract infections can be a challenging problem for urologists, emergency department staff, and primary providers. A recent study evaluated the utility of a multiplex polymerase chain reaction–based urinary tract infection analysis, showing noninferiority to classic urine culture testing and possible improvement in identifying polymicrobial infections.1 In addition, this testing benefits from a shorter time to diagnosis with sensitivity testing than traditional culture. Questions remain regarding how this testing might improve patient outcomes and health care utilization. The authors should be commended on their efforts to answer these difficult questions. Ko et al2 found that using polymerase chain reaction technology with pooled antibiotic testing (mPCR/P-AST) in patients with recurrent or complicated urinary tract infections may lead to decreased inpatient utilization and cost savings for the systems compared with standard urine cultures. The average treatment cost for urinary tract infection–related care was decreased by $500 in the mPCR/P-AST group. In addition, 23 percent of patients undergoing the mPCR/P-AST population were able to be treated as an outpatient compared with 53 percent of patients undergoing standard urine cultures. The authors conclude that the mPCR/P-AST approach is associated with reduced resource utilization and costs. Using a matched case-control design, the researchers examined the potential of using mPCR/P-AST in a real-world analysis of a retrospective sample of Medicare beneficiaries with recurrent or complicated urinary tract infections. After an index infection, patients using either the mPCR/P-AST or the standard urine culture exclusively were compared for the following year. The researchers used propensity score matching to mimic randomization by selecting appropriate controls (patients with standard urine culture). They used different statistical models to compare multiple outcomes, including additional urinary tract infections, urinary tract infection–related medical resource utilization, and urinary tract infection–related costs. The ultimate goal of mPCR/P-AST is to improve the care of patients with complex infections by offering faster and possibly improved diagnosis. The primary finding here is an improved rate of outpatient management between testing modalities; however, there is no improvement in rate or number of additional infections. Given the goal of more rapid diagnosis, this shift to outpatient management may hint at earlier microbe-directed treatment of infections compared with a traditional culture, thus preventing hospital admission. However, there is bias introduced by the retrospective design as providers selected their testing modality. A complicated infection may not trigger the need for a PCR test like a chronically catheterized patient with a recurrent infection because of the possibility for improved polymicrobial identification. Thus, selection bias may exist that could lead to inherent management differences between populations. Although the propensity score analysis attempts to address this bias, it can only account for variables measured in the data set and cannot account for unmeasured confounding. Second, the authors found that there was a reduction in costs on a systems level associated with the introduction of polymerase chain reaction testing. They conclude that the use of this method will help to reduce cost secondary to reduction in hospitalization for patients managed with this modality. As this was a study intended to examine resource utilization, the authors elected not to include the cost of the polymerase chain reaction testing in their final costs. Although increased outpatient utilization is a benefit from the patient perspective, the increased cost of testing, upward of $1,000, may be prohibitive to payers. Additional cost-benefit analyses are warranted. This study takes on the admirable challenge of evaluating a real-world population with thoughtful population definitions and analyses. There is undoubtedly a potential benefit to more efficient testing both for patients and the health care system; however, further study is necessary to confirm these findings.

A Diagnostic Test Combining Molecular Testing with Phenotypic Pooled Antibiotic Susceptibility Improved the Clinical Outcomes of Patients with Non-E. coli or Polymicrobial Complicated Urinary Tract Infections.

Complicated UTIs (cUTIs) cause significant morbidity and healthcare resource utilization and cost. Standard urine culture has limitations in detecting polymicrobial and non-E. coli infections, resulting in the under-diagnosis and under-treatment of cUTIs. In this study, patient-reported outcomes were compared between treated and untreated patients when an advanced diagnostic test combining multiplex-polymerase chain reaction (M-PCR) with a pooled antibiotic susceptibility method (P-AST) was incorporated into the patients' clinical management. Patients who had symptoms typical of cUTI and positive M-PCR/P-AST test results were recruited from urology clinics. Symptom reduction and clinical cure rates were measured from day 0 through day 14 using the American English Acute Cystitis Symptom Score (ACSS) Questionnaire. Clinical cure was defined based on the sum of the scores of four US Food and Drug Administration (FDA) symptoms and the absence of visible blood in the urine. Of 264 patients with suspected cUTI, 146 (55.4%) had exclusively non-E. coli infections (115 treated and 31 untreated) and 190 (72%) had polymicrobial infections (162 treated and 28 untreated). Treated patients exhibited greater symptom reduction compared to untreated ones on day 14 for those with exclusively non-E. coli organisms (3.18 vs 1.64, p = 0.006) and polymicrobial infections (3.52 vs 1.41, p = 0.002), respectively. A higher percentage of treated patients than of untreated patients achieved clinical cure for polymicrobial infections on day 14 (58.7% vs 36.4%, p = 0.049). Patients with cUTIs treated based on the M-PCR/P-AST diagnostic test had significantly improved symptom reduction and clinical cure rates compared to untreated patients among those with non-E. coli or polymicrobial infections.

Genetičke i genomske (molekularne) dijagnostičke metode u identifikaciji uzročnika infekcija mokraćnog sustava i urinarne mikrobiote

Standard urine culture (SUC) is a widespread diagnostic test. According to various guidelines, SUC is not a recommended first-line diagnostic tool for uncomplicated urinary tract infections (UTIs). However, its results are valuable in patients with complicated UTIs, hospitalized patients, and those who failed empirical antibiotic therapy. The emergence of antibiotic resistance has reaffirmed the urine culture as the gold standard in UTI workup. Nevertheless, turn-around-time and cost-effectiveness of SUC are the main incentives for continuous exploration of new, faster, and more sensitive procedures for evaluating the count and species of microorganisms and their susceptibility to antibiotics. Therefore, we considered it important to write a review that analyzes the advantages and disadvantages of state-of-the-art UTI diagnostics. We aim to compare standard cultivation methods with diagnostic modalities based on multiplex PCR, 16S RNA genes sequencing, and next-generation sequencing suitable for analyzing whole urinary microbiomes.

MP34-10 NATURAL HISTORY OF RECURRENT UTI: POOR RESOLUTION RATES WITHOUT PREVENTATIVE APPROACHES

You have accessJournal of UrologyCME1 Apr 2023MP34-10 NATURAL HISTORY OF RECURRENT UTI: POOR RESOLUTION RATES WITHOUT PREVENTATIVE APPROACHES Emma Dixon, Ashley Caron, and A. Lenore Ackerman Emma DixonEmma Dixon More articles by this author , Ashley CaronAshley Caron More articles by this author , and A. Lenore AckermanA. Lenore Ackerman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent UTIs (rUTIs) have an enormous healthcare burden. Many patients continue to experience recurrence of symptoms despite appropriate antibiotic treatment. We aimed to understand the natural history and progression of rUTI in women to determine the influence of patient factors, laboratory findings, and management approaches on recurrence. METHODS: Women aged 18-95 diagnosed between 2013-2015 by urogynecologic specialists with rUTI after in-person evaluation were followed for up to three subsequent visits for symptomatic complaints over the year following initial presentation. Patients with complicated UTIs or any history of pyelonephritis were excluded. Patient demographics, comorbidities, laboratory findings, treatments administered, and symptom resolution for each episode was recorded. RESULTS: Of a total of 101 women with rUTI, 70% (70/101) experienced recurrent symptoms within 1 year; 90% of these recurrences included acute dysuria prompting reevaluation. On multivariable logistic regression, only prior pelvic surgery (OR 0.15 [95% CI 0.03-0.8], p=0.02) was associated with lower recurrence rates, while preventative medications (prophylactic or post-coital antibiotics, vaginal estrogen) was the only variable significantly associated with symptomatic resolution (OR 4.85 [95% CI 1.1-22], p=0.04). Post-menopausal women more commonly experienced symptomatic resolution than pre-menopausal women (OR 20.4 [95% CI 0.83-502], p=0.06), and a comorbid diagnosis of anxiety or depression was more common in patients whose symptoms did not resolve (OR 0.09 [95% CI 0.01-1.06], p=0.08), although these trends did not reach statistical significance. Across all symptomatic episodes, 60% of urine cultures did not have microbiological evidence of infection. Only 2/70 (3%) subjects had positive cultures during all symptomatic episodes. There was no correlation between initial culture results and rates of symptomatic resolution or subsequent culture positivity. CONCLUSIONS: Spontaneous resolution of symptoms is not the natural history of rUTIs once established. Use of intermittent antibiotics to treat rUTIs is inferior to preventative measures at achieving symptomatic resolution. As most symptomatic episodes displayed negative urine cultures despite symptoms consistent with UTI, future studies will need to determine whether this discrepancy is due to poor sensitivity of standard urine culture or a higher than previously appreciated rate of confounding conditions presenting with similar symptoms as UTI. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e462 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emma Dixon More articles by this author Ashley Caron More articles by this author A. Lenore Ackerman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP34-06 THE ROLE OF MICROGENDX TESTING IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS AND NEGATIVE STANDARD URINE CULTURES

You have accessJournal of UrologyCME1 Apr 2023MP34-06 THE ROLE OF MICROGENDX TESTING IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS AND NEGATIVE STANDARD URINE CULTURES Rahul Dutta, Wyatt Whitman, Maxwell Sandberg, Stephen Walker, and Catherine Matthews Rahul DuttaRahul Dutta More articles by this author , Wyatt WhitmanWyatt Whitman More articles by this author , Maxwell SandbergMaxwell Sandberg More articles by this author , Stephen WalkerStephen Walker More articles by this author , and Catherine MatthewsCatherine Matthews More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with acute lower urinary tract symptoms (LUTS) and a negative standard urinary culture are challenging to manage. Some may have identifiable organisms on urinary polymerase-chain reaction (PCR) testing or next-generation DNA sequencing (NGS). We sought to better understand the relationship between patients with negative UC and positive (with an identifiable microbe) PCR/NGS that had treatment for LUTS directed towards the organism(s) on PCR/NGS. METHODS: Patients from a single academic center for which a MicroGenDX PCR/NGS sample was analyzed were retrospectively reviewed. Relationships between demographics, UC and urinalysis data, symptomatology, treatment data, and comorbidities were analyzed. RESULTS: A total of 122 patients were reviewed, of which 116 (95%) had identifiable bacteria and 17 (14%) had identifiable fungi on urinary PCR/NGS. Of these, 95 (81% female) had both negative UC and identifiable microbes on PCR/NGS and were therefore included in the following analysis. The most common reasons for urologic consultation were recurrent urinary tract infection (UTI, 27%), stone disease (21%), and LUTS (18%). Leukocytes were identified on 44% of patients who had a urinalysis at the time of PCR/NGS with negative UC. Forty-seven (54%) patients were treated with antimicrobials following PCR/NGS and 25 of them (53%) had resolution or improvement in their symptoms. There was no association between treatment success and gender, interstitial cystitis, stone disease, diabetes mellitus, vaginal prolapse beyond the hymen, menopausal status, vaginal estrogen use, or overactive bladder syndrome (p>0.05). There was no association between the presence of moderate or greater leukocytes on urinary dipstick and likelihood of symptomatic resolution with treatment (p>0.05). There was a trend to increased likelihood of symptomatic resolution in patients with identifiable fungi on UPCR (p=0.1131). CONCLUSIONS: In the small present study, most patients with lower urinary tract symptoms and a negative standard urine culture have identifiable pathologic microbes on urinary PCR/NGS testing. The clinical utility of PCR/NGS testing, however, is unclear as symptomatic improvement with targeted antimicrobial treatment occurred in only approximately half of these patients. No relationships with treatment success, urinalysis findings, or common medical comorbidities were found. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e461 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rahul Dutta More articles by this author Wyatt Whitman More articles by this author Maxwell Sandberg More articles by this author Stephen Walker More articles by this author Catherine Matthews More articles by this author Expand All Advertisement PDF downloadLoading ...

Ureaplasma: An overlooked pathogen

Ureaplasma is a less recognized pathogen found in women of all ages. Women with unexplained bladder pain, urethritis, or hematuria should be screened with an appropriate culture media; standard urine culture is not sufficient. When given antibiotics effective against ureaplasma (Doxycycline twice daily for at least a week) patients usually experience relief of symptoms within several days.

Nitrite-negative results in urinary tract infection by Enterobacterales: does the nitrite dipstick test have low sensitivity?

Urinary tract infection (UTI) is one of the most common bacterial infections among humans. Urine culture is the gold standard diagnostic method for UTI; however, the dipstick test for nitrite is a widely used method signalling the presence of urinary nitrate-reducing bacteria. Unlike the gold standard, the dipstick test is easy to perform, while it is also less time-consuming and less expensive, and produces a result in a few minutes. This study investigates the sensitivity of the dipstick test for nitrite compared with the Griess test in urine samples from UTI caused by Enterobacterales species. We used the Griess test, which is the gold standard in nitrite measurement, to determine the sensitivity of the nitrite dipstick test. Semiquantitative urine culture was performed using standard procedures, and Enterobacterales identification was performed by manual conventional biochemical tests. In the first sample selection, 3 % (8/267) of urine samples suspected of UTI, analysed from March to April 2016, were nitrite-negative by dipstick test but positive for Enterobacterales in the urine culture. In the second sample selection, 5 % (2/44) of urine samples from October to December 2022 were also nitrite-negative but showed urine Enterobacterales isolation. All nitrite-negative dipstick results were consistent with the Griess test. Escherichia coli was the most prevalent bacterium, followed by Klebsiella pneumoniae, independent of sample selection. The dipstick test is a safe alternative for investigating nitrite in urine samples. We believe that the cause of nitrite-negative results is a lack of dietary nitrate, dilution of urine and exogenous interference (e.g. ascorbic acid). These findings support the idea that standard urine culture is necessary to rule out UTI.

Tests for Early Detection of Paediatric Urinary Tract Infection

Urinary tract infection is the most common of all pediatric bacterial infections. This study aims to determine the efficacy of rapid diagnostic tests vs gram stain as against gold standard test (urine culture) and to find out the validity of each screening test for early detection of urinary tract infection in children. A cross-sectional study was conducted on children aged between 3- 15 years of suspected urinary tract infections from August 2020 to January 2021. Data collection was facilitated by using a predesigned checklist. The specimen was collected in a sterile, leak proof container by clean catch midstream technique and was subjected to urine microscopy, urine dipstick nitrite and leukocyte esterase, urine gram stain, and the gold standard test urine culture and sensitivity. Using the gold standard test, the sensitivity, specificity, positive predictive value, and negative predictive value of the other screening tests were determined. The patient's mean age was 5.16 ± 2.7 years, and half were in the age group 3-5 years. The majority of the patients were male (54%). Fever (64%) was the major symptom, followed by pain in the abdomen (52%) and dysuria (40%). Escherichia coli was the most common organism isolated (54%), followed by Klebsiella (22%). Urine gram stain has sensitivity and specificity of 95% and 100% respectively. Urinary tract infection is a common infection in children. Urine gram stain is a very sensitive and specific test for diagnosing urinary tract infections compared to other screening tests.

Modified reporting of positive urine cultures to reduce treatment of asymptomatic bacteriuria in long-term care facilities: a randomized controlled trial.

ObjectivesWe conducted a prospective, randomized, unblinded superiority trial of the safety and efficacy of modified reporting of positive urine cultures to improve the appropriateness of treatment for asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) in long-term care facilities (LTCFs).MethodsConsecutive positive urine cultures collected from LTCF patients were randomized between standard (identification and susceptibility) or modified (without identification and susceptibility) laboratory reports. Exclusion criteria were current antibiotic treatment, neutropenia, or transfer to acute care. The diagnosis of UTI or ASB was made prospectively.ResultsOne hundred and sixty-nine urine cultures were considered, 100 were randomized and included in ITT analysis, and 96 were included in PP analysis. Sixty-two out of 100 (62%) patients had ASB [41/62 (66%) treated] and 38/100 (38%) had UTI [35/38 (92%) treated]. The lab was called to report the identification and susceptibility in 31/51 (61%) modified reports. The rate of appropriate treatment was higher in the modified report arm: 31/51 (61%) versus 25/49 (51%) (+10%, P = 0.33). Untreated ASB was higher in the modified report arm: 13/32 (41%) versus 8/30 (27%) (+14%, P = 0.25). There were two deaths (one treated ASB, one untreated ASB) and 15 adverse events in the modified arm. There were no deaths (P = 0.16) and 11 adverse events (P = 0.43) in the standard arm. Three patients with untreated UTI survived.ConclusionsModified reporting of urine culture improved the appropriateness of treatment by reducing treatment of ASB, but not significantly. Many LTCF prescribers requested standard urine culture reports. Modified reporting may not be suitable for LTCF implementation.

Differential Urinary Microbiota Composition Between Women With and Without Recurrent Urinary Tract Infection.

BackgroundRecurrent urinary tract infection (RUTI) is common and burdensome in women. Due to the low concentration or slow-growing of uropathogens in RUTI, standard urine cultures (SUCs) are often negative. Next-generation sequencing (NGS) of bacterial 16S rRNA gene is more sensitive and could be used to reveal the differential microbiota between patients with RUTI and asymptomatic controls.MethodsWomen (aged ≥ 18 years) with clinically diagnosed RUTI with negative SUC and age-matched women asymptomatic controls with normal urinalysis were enrolled. Their midstream voided urine specimens were collected and processed for NGS (Illumina MiSeq) targeting the bacterial 16S rRNA gene V3-V4 region. The dataset was clustered into operational taxonomic units (OTUs) using QIIME. Taxonomic analysis, alpha diversity, beta diversity, multivariate statistical analysis, and linear discriminant analysis effect size (LEfSe) for differential analysis were performed and compared between patients with RUTI and asymptomatic controls.ResultsA total of 90 patients with RUTI and 62 asymptomatic controls were enrolled in this study. Among them, 74.4% (67/90) and 71.0% (44/62) were successfully amplified and sequenced their bacterial 16S rRNA gene. In the alpha diversity analysis, the chao1 index and observed species index were significantly lower in the RUTI group than in the control group (P = 0.015 and 0.028, respectively). In the beta diversity analysis, there was a significant difference between the 2 groups [Analysis of similarities (ANOSIM), R = 0.209, P = 0.001]. The relative abundance of 36 bacterial taxa was significantly higher, and another 24 kinds of bacteria were significantly lower in the RUTI group compared with the control group [LEfSe analysis, P < 0.05, linear discriminative analysis (LDA) score > 3], suggesting that Ralstonia, Prevotella, Dialister, and Corynebacterium may play an important role in RUTI.ConclusionThe urinary microbiota of women with clinically diagnosed RUTI were significantly different from age-matched asymptomatic controls.

PD32-09 COMPARISON OF GUIDANCE UTI® AND STANDARD URINE CULTURE FOR RATES OF SEPSIS, HOSPITALIZATION AND OTHER ADVERSE OUTCOMES IN COMPLICATED URINARY TRACT INFECTIONS

You have accessJournal of UrologyCME1 May 2022PD32-09 COMPARISON OF GUIDANCE UTI® AND STANDARD URINE CULTURE FOR RATES OF SEPSIS, HOSPITALIZATION AND OTHER ADVERSE OUTCOMES IN COMPLICATED URINARY TRACT INFECTIONS Aparna Ashok, Dicken Ko, Emily Lukacz, Annah Vollstedt, Iver Juster, Timothy Niecko, David Baunoch, and Mohit Mathur Aparna AshokAparna Ashok More articles by this author , Dicken KoDicken Ko More articles by this author , Emily LukaczEmily Lukacz More articles by this author , Annah VollstedtAnnah Vollstedt More articles by this author , Iver JusterIver Juster More articles by this author , Timothy NieckoTimothy Niecko More articles by this author , David BaunochDavid Baunoch More articles by this author , and Mohit MathurMohit Mathur More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002583.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complicated urinary tract infections (cUTI) are a significant burden on individual health and healthcare resources. They are often caused by polymicrobial infections where interactions between bacteria can change the antibiotic resistance of the pool of organisms. Guidance UTI® is a urine-based test that combines PCR and Pooled Antibiotic Susceptibility (P-AST), which tests for antibiotic susceptibility against the combined pool of organisms. This study sought to determine rates of adverse outcomes, medical resource utilization, and costs with Guidance UTI compared to standard urine culture (SUC). METHODS: Using a randomized 5% sample of Medicare Parts A+B beneficiaries enrolled in 2017-19 (n∼1.5M in each year), we compared 2 cohorts matched on sex, diabetes, and propensity score, based on whether outpatient UTI diagnosis was made with SUC (N=678) or Guidance UTI (N=69) initially, and for the year following their first cUTI after a 12-month baseline. UTI-related utilization and Medicare-allowed cost was acquired from professional and facility claims. RESULTS: The rate of outpatient emergency visits was 13% lower and inpatient admissions was 67% lower when using Guidance UTI compared to SUC. For every 1,000 patients there were zero urosepsis, urgent care and skilled nursing facility admissions with Guidance UTI vs 13, 31 and 7 events respectively with SUC. For the composite outcome, Guidance UTI testing was associated with a 42% reduction compared to SUC (Figure 1). These reductions translate to $463.46 saving per cUTI patient tested with Guidance UTI (p=0.043), a saving of $11.6 million for 25,000 cUTI cases (Table 1). CONCLUSIONS: Guidance UTI testing is associated with reductions in critical adverse outcomes, healthcare resource utilization and cost for cUTI cases as compared to standard urine culture. cUTI cases may benefit from Guidance UTI’s combination of increased sensitivity, reduced time to results, and P-AST results. Source of Funding: Pathnostics © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e550 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aparna Ashok More articles by this author Dicken Ko More articles by this author Emily Lukacz More articles by this author Annah Vollstedt More articles by this author Iver Juster More articles by this author Timothy Niecko More articles by this author David Baunoch More articles by this author Mohit Mathur More articles by this author Expand All Advertisement PDF DownloadLoading ...

Accuracy of molecular diagnostic techniques in patients with a confirmed urine culture: A systematic review and meta-analysis.

We aimed to identify the molecular diagnostic techniques available for urinary tract infection (UTI) diagnosis and their accuracy compared to traditional urinary culture. A systematic search was performed in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL). The populations were adult and pediatric patients with confirmed UTI by reference standard urine culture. The index test for the diagnosis of UTI was any molecular diagnostic technique. The primary outcome was the diagnosis of UTI with measures of sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and area under the curve (AUC). The operative characteristics were determined, and a meta-analysis was performed. The evaluation of each included study was performed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We identified 1230 studies with the search strategies. Ultimately, 13 studies met the inclusion criteria for qualitative analysis, and seven were included for the meta-analysis. Four molecular techniques were identified; however, it was only possible to synthesize the information from two of them. In multiplex polymerase chain reaction (PCR) meta-analysis, overall sensitivity was 0.80 (95% confidence interval [CI] 0.73-0.86) and specificity was 0.83 (95% CI 0.52-0.95). For the DOR, the overall result was 21 (95% CI 4.8-95). For reverse transcription (RT)-PCR, sensitivity was 0.94 (95% CI 0.73-0.99) and specificity was 0.59 (95% CI 0.063-0.96). For the DOR, the overall result was 23 (95% CI 1.1-467). Multiplex PCR and RT-PCR are molecular techniques that might be comparable to standard urine culture for UTI diagnosis. Refinement of these new diagnostic tools will avoid unnecessary antimicrobial therapy and the consequent development of drug-resistant resistant pathogens, as well as improve the ability to identify patients at risk and prevent or minimize sequelae derived from the infection.

Polymicrobial growth in standard urine culture: Time to Act or Ignore?

Diagnosing Urinary Tract Infections (UTI) remains a clinical challenge. A monobacterial growth in standard urine culture is diagnostic while polymicrobial growth is usually considered as contaminants. However, in certain cases, true mixed infections may exist making it important to correctly identify the pathogens and streamline the therapy. Communication between the clinician and microbiologist is essential to establish the right diagnosis at right time. Here, we would like to share our experience about a polymicrobial UTI in a paediatric patient in which coordinated discussion between the clinical team and microbiologist was helpful for favourable outcome.

Distinguishing Features of the Urinary Bacterial Microbiome in Patients with Neurogenic Lower Urinary Tract Dysfunction.

We aimed to characterize the urinary microbiome of catheterizing patients with neurogenic lower urinary tract dysfunction (NLUTD) and to evaluate differences based on type of bladder management or frequency of urinary tract infections. This is a prospective, cross-sectional study of urine samples from asymptomatic, catheterizing patients with neurogenic lower urinary tract dysfunction who used either clean intermittent catheterization or indwelling catheters. Patients without symptoms of urinary tract infection provided a catheterized urine sample for urinalysis, culture and bacterial community microbiome analysis. A total of 95 patients submitted urine for analysis, of whom 69 had sufficient sequence reads (>1,203) for microbiome analysis. Cases with low bacterial signal amplification were associated with use of vaginal estrogen, no intradetrusor botulinum toxin A use and no growth on standard urine culture. The most abundant operational taxonomic units were from the phylum Proteobacteria, classified as Enterobacteriaceae and Escherichia. Alpha diversity varied among those who used indwelling catheters vs clean intermittent catheterization, and those who underwent botulinum toxin A injection vs not. On linear discriminate analysis, the relative abundance of the operational taxonomic units identified as Pseudomonas was higher among patients using indwelling catheters relative to clean intermittent catheterization. The operational taxonomic unit identified as Aerococcus was at a higher relative abundance among males compared to females. Enterobacteriaceae and Escherichia were the most abundant genera in the urinary microbiome of patients with neurogenic lower urinary tract dysfunction. Urinary microbiome diversity varied based on bladder management type. Future clinical correlations between microbiome of neurogenic patients and clinical presentation may help guide treatment strategies.

This Month in Adult Urology

This Month in Adult Urology