What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection?

Abstract

Background: Urinary tract infection (UTI) affects half of women at least once in their lifetime. Current diagnosis involves urinary dipstick and urine culture, yet both methods have modest diagnostic accuracy, and cannot support decision-making in patient populations with high prevalence of asymptomatic bacteriuria, such as older adults. Detecting biomarkers of host response in the urine of hosts has the potential to improve diagnosis. Objectives: To synthesise the evidence of the diagnostic accuracy of novel biomarkers for UTI, and of their ability to differentiate UTI from asymptomatic bacteriuria. Design: A systematic review. Data Sources and Methods: We searched MEDLINE, EMBASE, CINAHL and Web of Science for studies of novel biomarkers for the diagnosis of UTI. We excluded studies assessing biomarkers included in urine dipsticks as these have been well described previously. We included studies of adult patients (≥16 years) with a suspected or confirmed urinary tract infection using microscopy and culture as the reference standard. We excluded studies using clinical signs and symptoms, or urine dipstick only as a reference standard. Quality appraisal was performed using QUADAS-2. We summarised our data using point estimates and data accuracy statistics. Results: We included 37 studies on 4009 adults measuring 66 biomarkers. Study quality was limited by case-control design and study size; only 4 included studies had a prospective cohort design. IL-6 and IL-8 were the most studied biomarkers. We found plausible evidence to suggest that IL-8, IL-6, GRO-a, sTNF-1, sTNF-2 and MCR may benefit from more rigorous evaluation of their potential diagnostic value for UTI. Conclusions: There is insufficient evidence to recommend the use of any novel biomarker for UTI diagnosis at present. Further evaluation of the more promising candidates, is needed before they can be recommended for clinical use.

Elevated UTI Biomarkers in Symptomatic Patients with Urine Microbial Densities of 10,000 CFU/mL Indicate a Lower Threshold for Diagnosing UTIs

“…The biomarkers used in this study [neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-8), and interleukin-1-beta (IL-1β)] are essential components of the constitutive immune response in the urinary tract and have been studied in association with UTIs. Importantly, these three biomarkers have also demonstrated utility for the diagnosis of UTIs [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. One of our previous studies discovered that NGAL, IL-8, and IL-1β have sensitivities of 82.6%, 91.2%, and 69.8% with specificities of 90.8%, 76.8%, and 96.9%, respectively [ 29 ].…”

Estimation of Interleukin -6 and Tumor Necrosis Factor-Alpha Levels in Menopausal Women with Urinary Tract Infections

“…IL-6 play a protective role during bladder infection, on the other hand in deficiency of IL-6 lead to increases the number of intracellular bacterial communities (IBC) that allow Uropathogenic Escherichia Coli (UPEC) to evade the innate immune system and contribute in urinary tract infection (Edwards et al, 2023).…”

Young Women’s Attitudes and Behaviors in Treatment and Prevention of UTIs: Are Biomedical Students at an Advantage?

“…A systematic review of such interventions concluded that they may lead to increase of treatments with first-choice antibiotics and a decrease number of treatments with broad-spectrum antibiotics [2]. For example, at-home testing kits may ease the burden GPs face when treating UTIs, as they may aid the accuracy of UTI diagnosis and help to distinguish patients who would benefit from antibiotic treatment from those who do not need it [9,10]. There have been vaccines developed for prevention of recurrent UTIs as well, offering greater protection than antimicrobial prophylaxis [11].…”