A review on urinary tract infections diagnostic methods: Laboratory-based and point-of-care approaches

Santos, Marta; Mariz, Marcos; Tiago, Igor; Martins, Jimmy; Alarico, Susana; Ferreira, Paula

doi:10.1016/j.jpba.2022.114889

Cited by 20 publications

(19 citation statements)

References 82 publications

(97 reference statements)

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“…National guidelines recommend not to perform urine dipstick testing in patients aged 65 years or older due to asymptomatic bacteriuria which if present and tested may lead to false positive results. 49 Other studies also report overuse of urine dipstick tests. A study by Cooper et al 50 reported that some clinicians would not ask for a urine dipstick if the patient was symptomatic with all three diagnostic UTI symptoms (urinary frequency, dysuria and urgency), while others would.…”

Section: Discussionmentioning

confidence: 99%

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Knowledge and attitude factors influencing primary care clinicians' diagnosis, treatment and management of urinary tract infections in women: A qualitative ‘think’ aloud study in England

Mwape

Schmidtke

Brown

2023

Repro Female Child Health

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ObjectivesThe present study aimed to identify factors related to knowledge and attitudes that influence primary care clinicians' decision‐making when diagnosing, treating, and managing suspected urinary tract infections (UTIs) in women. Understanding the factors that influence clinicians' decision‐making is important for maximising health outcomes in women and reducing suboptimal use of antibiotics and antimicrobial resistance.DesignA qualitative think‐aloud study design was employed.MethodsSemi‐structured qualitative interviews were conducted with primary care clinicians in England over Microsoft Teams. Interviews were transcribed and coded in two ways. First, clinicians' responses for each scenario were coded as either following (optimal), not following evidence‐based national guideline or incorrectly citing certain diagnosis, treatment, and management procedures (suboptimal). Second, the knowledge and attitude factors that influenced decision‐making were coded according to an empirically informed umbrella framework. Clinicians external to the study team reviewed the findings to promote their trustworthiness and utility.ResultsTen clinicians (six female) took part. Clinicians prescribing decisions were mostly influenced by knowledge rather than attitude factors. Despite clinicians expressing high awareness of relevant evidence‐based guidelines (a knowledge factor) and high confidence (an attitude factor), more than half of their decisions (60%) were suboptimal in some way thereby impacting women's health. Most clinicians relied on their experiential knowledge rather than using evidence‐based guidelines. Our results suggest that knowledge could impede adherence, for example, where local guidelines conflict with national guidelines of when to perform a urine dipstick test.ConclusionsSuboptimal prescribing decisions could result from a combination of different knowledge and attitude factors leading to negative outcomes in women's health such as inappropriate treatment of asymptomatic bacteriuria in women over 65 years old. To optimise antibiotic prescribing in women, policy‐level interventions could increase concordance across local and national guidelines, or more tailored individual‐level interventions could help clinicians recognise where their experiential knowledge causes deviations from evidence‐based guidelines when diagnosing, treating and managing UTIs.

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Section: Discussionmentioning

confidence: 99%

“…This is not in alignment with national guidelines. National guidelines recommend not to perform urine dipstick testing in patients aged 65 years or older due to asymptomatic bacteriuria which if present and tested may lead to false positive results 49 . Other studies also report overuse of urine dipstick tests.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and attitude factors influencing primary care clinicians' diagnosis, treatment and management of urinary tract infections in women: A qualitative ‘think’ aloud study in England

Mwape

Schmidtke

Brown

2023

Repro Female Child Health

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“…UTIs are common infections that affect individuals of all age groups and are associated with frequent episodes of recurrence and relapse, especially in post‐menopausal women. UTIs, though a common cause of mortality worldwide, is often undiagnosed (especially in resource‐challenged settings due to limited access to laboratory culture tests) and when left untreated can result in severe sequelae such as sepsis and even death, as the causative pathogen ascends from the lower urinary tract to the upper urinary tract and ultimately spread into the bloodstream 12,13,43,49,50 . Thus, tracking the progression of the disease, in a time‐critical fashion, is key for treatment success.…”

Section: Discussionmentioning

confidence: 99%

“…UTIs, though a common cause of mortality worldwide, is often undiagnosed (especially in resource-challenged settings due to limited access to laboratory culture tests) and when left untreated can result in severe sequelae such as sepsis and even death, as the causative pathogen ascends from the lower urinary tract to the upper urinary tract and ultimately spread into the bloodstream. 12,13,43,49,50 Thus, tracking the progression of the disease, in a time-critical fashion, is key for treatment success. To achieve this, we have developed a rapid UTI biosensor that measures inflammatory biomarkers which are expressed in urine in response to the underlying infection, regardless of the type of pathogen (commonly bacteria).…”

Section: Discussionmentioning

confidence: 99%

DigEST: Digital plug‐n‐probe disease Endotyping Sensor Technology

Ganguly

Ebrahimzadeh

Komarovsky

et al. 2022

Bioengineering & Transla Med

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In this work, we propose a novel diagnostic workflow-DigEST-that will enable stratification of disease states based on severity using multiplexed point of care (POC) biosensors. This work can boost the performance of current POC tests by enabling clear, digestible, and actionable diagnoses to the end user. The scheme can be applied to any disease model, which requires time-critical disease stratification for personalized treatment. Here, urinary tract infection is explored as the proof-ofconcept disease model and a four-class classification of disease severity is discussed.Our method is superior to traditional enzyme-linked immunosorbent assay (ELISA) as it is faster and can work with multiple disease biomarkers and categorize diseases by endotypes (or disease subtype) and severity. To map the nonlinear nature of biochemical pathways of complex diseases, the method utilizes an established supervised machine learning model for digital classification. This scheme can potentially boost the diagnostic power of current electrochemical biosensors for better precision therapy and improved patient outcomes.

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“…Rapid, simple and accurate methods for the detection of UTI pathogens are essential for the selection of antibiotics and patient management ( Raja et al, 2017 ). Various approved methods have been developed to improve the diagnosis of UTIs ( Davenport et al, 2017 ; Santos et al, 2022 ). Urine dipstick tests for urine nitrite and leukocyte esterase are widely used for early diagnosis of UTI, because of their cost effectiveness and clinical utility.…”

Section: Introductionmentioning

confidence: 99%

Multiplex high-resolution melting assay for simultaneous detection of five key bacterial pathogens in urinary tract infections: A pilot study

et al. 2022

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The diagnosis of urinary tract infections (UTIs) is usually based on the results of urine culture, but it is time-consuming, labor-intensive and has a low sensitivity. The aim of this study was to develop multiplex high-resolution melting assay (MHRM) for the simultaneous detection of five common bacterial pathogens (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus, Enterococcus faecalis, and group B streptococci (GBS)) directly from urine samples. A total of 287 urine specimens were evaluated by HRM assay and the results were compared with the conventional culture method. Five different melt curves generated and differentiated five bacterial pathogens. The detection limit of the MHRM assay was 1.5 × 103 CFU/ml for E. coli and K. pneumoniae and 1.5 × 102 CFU/ml for S. saprophyticus, E. faecalis and GBS. Compared to culture, the specificity of the MHRM assay ranged from 99.3 to 100%, and sensitivity 100% for all test pathogens. The MHRM assay developed in the current study might be functional tool for the diagnosis of UTIs and has the potential for direct detection of the organism in the clinical samples. Additionally, it creates results in less than 5 h, helping clinicians to start treatment with appropriate antimicrobial agents. This method could be a useful supplement to urine culture.

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A review on urinary tract infections diagnostic methods: Laboratory-based and point-of-care approaches

Cited by 20 publications

References 82 publications

Knowledge and attitude factors influencing primary care clinicians' diagnosis, treatment and management of urinary tract infections in women: A qualitative ‘think’ aloud study in England

Knowledge and attitude factors influencing primary care clinicians' diagnosis, treatment and management of urinary tract infections in women: A qualitative ‘think’ aloud study in England

DigEST: Digital plug‐n‐probe disease Endotyping Sensor Technology

Multiplex high-resolution melting assay for simultaneous detection of five key bacterial pathogens in urinary tract infections: A pilot study

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