Urine biomarkers individually and as a consensus model show high sensitivity and specificity for detecting UTIs

BMC Infectious Diseases, Journal Year: 2024, Volume and Issue: 24(1)

Published: Jan. 31, 2024

Abstract Background Current diagnoses of urinary tract infection (UTI) by standard urine culture (SUC) has significant limitations in sensitivity, especially for fastidious organisms, and the ability to identify organisms polymicrobial infections. The rate both SUC “negative” or “mixed flora/contamination” results UTI cases high prevalence asymptomatic bacteriuria indicate need an accurate diagnostic test help true cases. This study aimed determine if infection-associated biomarkers can differentiate definitive from non-UTI controls. Methods Midstream clean-catch voided samples were collected volunteers symptomatic subjects ≥ 60 years old diagnosed with a urology specialty setting. Microbial identification density assessed using multiplex PCR/pooled antibiotic susceptibility (M-PCR/P-AST) SUC. Three [neutrophil gelatinase-associated lipocalin (NGAL), Interleukins 8 1β (IL-8, IL-1β)] also measured via enzyme-linked immunosorbent assay (ELISA). Definitive defined as diagnosis positive microorganism detection M-PCR, while volunteers. Results We observed strong correlation (R 2 > 0.90; p < 0.0001) between microbial NGAL, IL-8, IL-1β subjects. Biomarker consensus criteria two more had sensitivity 84.0%, specificity 91.2%, predictive value 93.7%, negative 78.8%, accuracy 86.9%, likelihood ratio 9.58, 0.17 differentiating cases, regardless non-zero density. showed elevation microbe compared without identification. exhibited distinguishing Conclusion demonstrated that IL-1β, and/or M-PCR was associated A criterion meeting positivity thresholds good balance (84.0%), (91.2%), (86.9%). Therefore, this biomarker is excellent supportive tool resolving presence active UTI, particularly disagree.

Language: Английский

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The Prevalence and Association of Different Uropathogens Detected by M-PCR with Infection-Associated Urine Biomarkers in Urinary Tract Infections

Research and Reports in Urology, Journal Year: 2024, Volume and Issue: Volume 16, P. 19 - 29

Published: Jan. 1, 2024

Background: Many emerging uropathogens are currently identified by multiplex polymerase chain reaction (M-PCR) in suspected UTI cases. Standard urine culture (SUC) has significantly lower detection rates, raising questions about whether these organisms associated with UTIs and truly cause inflammation. Objective: To determine if microbes detected M-PCR were likely causative of measuring inflammatory biomarkers the symptomatic patients. Design, Setting, Participants: Midstream voided was collected from subjects ≥ 60 years presenting to urology clinics symptoms (n = 1132) between 01/2023 05/2023. Microbe inflammation-associated biomarker (neutrophil gelatinase-associated lipocalin, interleukin 8, 1β) enzyme-linked immunosorbent assay. Biomarker positivity measured against individual groups organisms, E. coli non- cases, uropathogens, monomicrobial polymicrobial Outcome Measurements Statistical Analysis: Distributions compared using 2-sample Wilcoxon Rank Sum test 2-tailed p-values < 0.05 considered statistically significant. Results Limitations: positive 823 (72.7%) specimens 28 30 (93%) microorganisms/groups detected. Twenty-six twenty-eight had 2 > 66% Both cases significant (p 0.05). Limitations that a few low prevalence making inferences their significance difficult. Conclusion: The majority microorganisms active inflammation positivity, indicating they This includes frequently not standard culture. Plain Language Summary: assay is novel diagnostic for UTI. study found most included were:detected patients at least age presumptive diagnosisassociated infection Thus, assay:is clinically relevanthas likelihood false-positivity Keywords: testing, IL-8, IL-1β, M-PCR, NGAL,

Language: Английский

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Pooled Antibiotic Susceptibility Testing for Polymicrobial UTI Performs Within CLSI Validation Standards

Antibiotics, Journal Year: 2025, Volume and Issue: 14(2), P. 143 - 143

Published: Feb. 1, 2025

Background/Objectives: Urinary tract infections (UTIs) pose an increasing risk of antimicrobial resistance, and novel diagnostic tests have been developed to address the limitations standard urine culture in these cases. It is important that be validated for agreement error rates against antibiotic susceptibility testing (AST) methods. Methods: Polymicrobial (≥two non-fastidious microorganisms) consecutive clinical specimens submitted UTI were included this analysis. Specimens tested with Pooled Antibiotic Susceptibility Testing (P-AST) broth microdilution/disk diffusion (BMD/DD) parallel. Performance characteristics, such as essential (EA%), very major errors (VMEs), (MEs), assessed using Clinical Laboratory Standards Institute (CLSI) standards. P-AST-resistant BMD/DD consensus-sensitive results heteroresistance. Real-world sample data used assess associations between organism counts average “sensitive” count per sample. Results: The P-AST isolate AST was ≥90%, VMEs <2.0%, MEs <3.0%, meeting CLSI guidelines verification validation studies. When heteroresistance accounted for, overall both <1.5%. presence additional organisms dropped number antibiotics from 9.8 one 2.5 five or more organisms. fastidious did not any meaningful impact. Conclusions: P-AST, a component Guidance® assay (Pathnostics, Irvine, CA, USA), performed within standards polymicrobial specimens.

Language: Английский

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Comparison Shows that Multiplex Polymerase Chain Reaction Identifies Infection-associated Urinary Biomarker–positive Urinary Tract Infections That Are Missed by Standard Urine Culture

European Urology Open Science, Journal Year: 2023, Volume and Issue: 58, P. 73 - 81

Published: Nov. 8, 2023

Multiplex polymerase chain reaction (M-PCR) has increased sensitivity for microbial detection compared with standard urine culture (SUC) in cases diagnosed as urinary tract infections (UTIs), leading to questions whether detected microbes are likely causative of UTIs or incidental findings. To compare infection-associated biomarker levels against M-PCR and SUC results symptomatic a presumptive diagnosis UTI by urologist. Participants were ≥60 yr old presented urology clinics between January April 2023 symptoms (n = 583). Urine was SUC. Three biomarkers (neutrophil gelatinase-associated lipocalin, interleukin-8, interleukin-1β) measured enzyme-linked immunosorbent assay. Symptomatic elevated biomarkers, uropathogens, specialist clinical considered definitive cases. Distributions using two-sample Wilcoxon rank sum test, two-tailed p values <0.05 statistically significant. In M-PCR–positive/SUC-negative 80), all median significantly higher (p < 0.0001) than M-PCR–negative/SUC-negative 107). Two more positive 76% specimens. Limitation an inability examine associations each individual organism inflammation. A significant number had infection-related especially when infection caused organisms other Escherichia coli. This is strong indication that M-PCR, which would be missed SUC, associated UTIs. We patients (UTIs) the microorganisms multiplex (M-PCR). found most markers inflammation, indicating these

Language: Английский

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Evaluation of diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin in patients with symptoms of urinary tract infections: a meta-analysis

Frontiers in Pediatrics, Journal Year: 2024, Volume and Issue: 12

Published: May 22, 2024

Introduction Early and accurate diagnosis of urinary tract infection (UTI) can prevent serious sequelae including chronic kidney disease. Multiple individual studies have identified urine neutrophil gelatinase-associated lipocalin (uNGAL) as a promising biomarker for early UTI. We sought to understand the distribution diagnostic accuracy uNGAL values in patients presenting with UTI symptoms. Methods Our systematic literature reviews PubMed, Embase, Cochrane Reviews up March 2024, 25 reporting mean/median, standard deviation/quartiles, detection limits symptomatic without culture-confirmed Seventeen were children. Meta-analyses performed using quantile estimation (QE) method estimating distributions uNGAL, which then compared between non-UTI groups identifying best cut-off points maximizing Youden index. Sensitivity analyses on all adult patients. Results found that levels significantly higher samples confirmed those without. In pediatric studies, median 95% confidence interval (CI) 22.41 (95% CI 9.94, 50.54) ng/mL group vs. 118.85 43.07, 327.97) group. estimated point 48.43 highest sensitivity (96%) specificity (97%) analysis both yielded similar results. Discussion The level is much than reported It may be used tool identify among range concentrations subjects lower acute intrinsic injury. Systematic Review Registration https://www.crd.york.ac.uk/ , PROSPERO (CRD42023370451).

Language: Английский

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The Urinary Microbiome

Infectious Disease Clinics of North America, Journal Year: 2024, Volume and Issue: 38(2), P. 241 - 253

Published: May 8, 2024

Language: Английский

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Emerging and Fastidious Uropathogens Were Detected by M-PCR with Similar Prevalence and Cell Density in Catheter and Midstream Voided Urine Indicating the Importance of These Microbes in Causing UTIs

Infection and Drug Resistance, Journal Year: 2023, Volume and Issue: Volume 16, P. 7775 - 7795

Published: Dec. 1, 2023

Introduction: This study compared microbial compositions of midstream and catheter urine specimens from patients with suspected complicated urinary tract infections to determine if emerging fastidious uropathogens are infecting the bladder or contaminants. Methods: Urine was collected by in-and-out (n = 1000) voiding 2000 adult (≥ 60 years age) at 17 DispatchHealth sites across 11 states. The two groups were matched age (mean 81 years), sex (62.1% female, 37.9% male), ICD-10-CM codes. Microbial detection performed multiplex polymerase chain reaction (M-PCR) a threshold for "positive detection" ≥ 10,000 cells/mL bacteria any yeast. Results divided sex. Results: In females, 28 30 microorganisms/groups found both collection methods, while in males 26 both. There significant overlaps densities classical including Escherichia coli, Enterococcus faecalis , Klebsiella pneumoniae as well Actinotignum schaalii Aerococcus urinae . rates slightly higher voided catheter-collected (p 0.0005) samples, showed opposite trend < 0.0001). More polymicrobial detected samples (64.4% vs 45.7%, p 0.0001) females but (35.6% 47.0%, 0.002). Discussion: In-and-out shared similarities detections M-PCR, some differences small subset organisms between sexes. Conclusion: Non-invasive identification cases presumed UTI does not result significantly more contamination specimens. Additionally, long regarded contaminants should be reconsidered potential uropathogens. Keywords: infection, standard culture, diagnostic testing, reaction, catheter,

Language: Английский

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From Awareness to Action: Pioneering Solutions for Women’s UTI Challenges in the Era of Precision Medicine

International Journal of Women s Health, Journal Year: 2024, Volume and Issue: Volume 16, P. 1595 - 1605

Published: Sept. 1, 2024

This article aims to bring clinicians' awareness the widespread impact of urinary tract infection (UTI) on lives women and advances that offer hope for future improvements in diagnosis management UTI. Thanks physiological, anatomical, lifestyle factor differences, face heightened vulnerability UTIs compared men. In fact, are four times more likely than men develop a UTI around half these encounter recurrence, which is significant source both physical psychosocial burdens. Despite current shortcomings management, emerging diagnostic technologies promise identify accurately rapidly, offering revolution management. Meanwhile, clinicians have opportunity reduce burden by recognizing value patients' lived experiences ensuring their care plan alignment with goals expectations medical care.

Language: Английский

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Rapid and accurate testing for urinary tract infection: new clothes for the emperor

Clinical Microbiology Reviews, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 6, 2024

SUMMARY Urinary tract infection (UTI) is among the most common infections in clinical practice. In some cases, if left untreated, it can lead to pyelonephritis and urosepsis. other UTI resolves without treatment. Clinical diagnosis typically based on patient symptoms and/or urinalysis, including urine dipsticks. The standard culture method sometimes employed identify suspected urinary pathogen (uropathogen) guide antimicrobial choice, but results are rarely available before 24 h. also misses fastidious, anaerobic, slow-growing uropathogens reports polymicrobial infections. unexplained combination of negative cultures with persistent distressing both patients clinicians. Given broad appreciation advantages provided by rapid testing (e.g., for COVID-19 or influenza A), a rapid, accurate diagnostic test needed deliver timely treatment seeking care that optimizes antibiotic stewardship. Herein, we discuss progress being made toward an accessible, (i.e., within hours), assay clinically useful treating clinician timeframe growth rate pathogen(s)). New emerging often overlooked current techniques reviewed.

Language: Английский

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Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

Current Opinion in Urology, Journal Year: 2024, Volume and Issue: 34(3), P. 146 - 153

Published: March 1, 2024

This review aims to present the recent literature regarding effects of aging and ureteral stent implantation (UrS) on risk urinary tract infections (UTIs) in kidney transplant (KTX) recipients.

Language: Английский

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