Multiplex PCR Based Urinary Tract Infection (UTI) Analysis Compared to Traditional Urine Culture in Identifying Significant Pathogens in Symptomatic Patients

Abstract

To evaluate whether multiplex PCR-based molecular testing is noninferior to urine culture for detection of bacterial infections in symptomatic patients. METHODS Retrospective record review of 582 consecutive elderly patients presenting with symptoms of lower urinary tract infection (UTI) was conducted. All patients had traditional urine cultures and PCR molecular testing run in parallel. RESULTS A total of 582 patients (mean age 77; range 60-95) with symptoms of lower UTI had both urine cultures and diagnostic PCR between March and July 2018. PCR detected uropathogens in 326 patients (56%, 326/582), while urine culture detected pathogens in 217 patients (37%, 217/582). PCR and culture agreed in 74% of cases (431/582): both were positive in 34% of cases (196/582) and both were negative in 40% of cases (235/582). However, PCR and culture disagreed in 26% of cases (151/582): PCR was positive while culture was negative in 22% of cases (130/582), and culture was positive while PCR was negative in 4% of cases (21/582). Polymicrobial infections were reported in 175 patients (30%, 175/582), with PCR reporting 166 and culture reporting 39. Further, polymicrobial infections were identified in 67 patients (12%, 67/582) in which culture results were negative. Agreement between PCR and urine culture for positive cultures was 90%, exceeding the noninferiority threshold of 85% (95% conflict of interest 85.7%-93.6%). CONCLUSION Multiplex PCR is noninferior to urine culture for detection and identification of bacteria. Further investigation may show that the accuracy and speed of PCR to diagnose UTI can significantly improve patient outcomes. UROLOGY 136: 119−126, 2020.

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

“…The introduction of multiplex PCR testing, which utilizes multiple primers to detect several targets at once has dramatically reduced the cost and time associated with this class of test as well as increasing its utility in clinical medicine [32]. It is particularly useful for identifying infectious agents, and has been studied for several types of infections including but not limited to bloodstream infections, sexually transmitted infections, and gastrointestinal infections [33]. The appeal of PCR-based diagnostic testing for UTI's lies in its high specificity and sensitivity as well as the rapidity with which results can be obtained compared to standard bacterial cultures for the previously named infections [34][35][36], among others.…”

“…The appeal of PCR-based diagnostic testing for UTI's lies in its high specificity and sensitivity as well as the rapidity with which results can be obtained compared to standard bacterial cultures for the previously named infections [34][35][36], among others. PCR not only has higher detection rates of single pathogens compared to urine culture [37][38][39], but has been shown to be effective in detecting multiple pathogens in urine, which standard urine cultures routinely fail to do [33]. This is of great importance considering that between 30-39% of UTI's are polymicrobial [33,[40][41][42] and appropriate antimicrobial treatment is dependent on accurate identification of the causative organisms.…”

“…PCR not only has higher detection rates of single pathogens compared to urine culture [37][38][39], but has been shown to be effective in detecting multiple pathogens in urine, which standard urine cultures routinely fail to do [33]. This is of great importance considering that between 30-39% of UTI's are polymicrobial [33,[40][41][42] and appropriate antimicrobial treatment is dependent on accurate identification of the causative organisms. Antibiotic resistance in UTI's is seen in both inpatient and outpatient cases of infection [43] and targeted treatment is an important facet of antibiotic stewardship to prevent the continued propagation of resistant pathogens.…”

Outpatient Urinary-Tract-Infection-Like Symptoms: Causative Microbial Survey Utilizing Multiplex Quantitative Polymerase Chain Reaction Methodology

“…Due to significant maternal colonization or infection, and subsequent fetal transmission, a growing body of evidence supports pre-natal diagnosis (preferably by a NAAT methodology) and treatment of these microbes [32] [33] We found that detection of polymicrobial infections (3 or more pathogens) in the urine samples of the pregnant population was significantly higher than the overall detection rate ( Figure 4). A recent study of symptomatic UTI patients demonstrated that multiplex PCR was able to detect the presence of pathogenic agents in 36% of concurrent, parallel "split samples", that tested negative with traditional culture techniques [34]. In addition, the same study detected polymicrobial infections in 12% of culture negative samples.…”

Epididymitis and its aetiologies in a central London sexual health clinic

“…10 Multiplex PCR based tests for UTI can improve the detection rate of uropathogens when widely available. 11 Identification of UTI pathogens should trigger a referral pathway to urology services for further evaluation of prostate and urinary tract pathology.…”