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.

IF 2 Q2 UROLOGY & NEPHROLOGY

Research and Reports in Urology Pub Date : 2023-01-01 DOI:10.2147/RRU.S404260

Howard J Korman, David Baunoch, Natalie Luke, Dakun Wang, Xihua Zhao, Michael Levin, David L Wenzler, Mohit Mathur

{"title":"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.","authors":"Howard J Korman, David Baunoch, Natalie Luke, Dakun Wang, Xihua Zhao, Michael Levin, David L Wenzler, Mohit Mathur","doi":"10.2147/RRU.S404260","DOIUrl":null,"url":null,"abstract":"Purpose: 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.Methods: 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.Results: 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).Conclusion: 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.","PeriodicalId":21008,"journal":{"name":"Research and Reports in Urology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/06/rru-15-141.PMC10162393.pdf","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research and Reports in Urology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/RRU.S404260","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 2

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

查看原文本刊更多论文

一项结合分子检测和表型汇总抗生素敏感性的诊断试验改善了非e型结核患者的临床预后。大肠杆菌或多种微生物并发尿路感染。

目的:复杂性尿路感染(cUTIs)造成严重的发病率和医疗资源利用及成本。标准尿液培养在检测多种微生物和非大肠杆菌方面存在局限性。大肠杆菌感染，导致cUTIs的诊断和治疗不足。在本研究中，将多重聚合酶链反应(M-PCR)和合并抗生素药敏法(P-AST)相结合的先进诊断测试纳入患者的临床管理，比较了治疗和未治疗患者的患者报告的结果。方法:从泌尿外科门诊招募具有典型cUTI症状且M-PCR/P-AST检测结果阳性的患者。使用美式英语急性膀胱炎症状评分(ACSS)问卷从第0天到第14天测量症状减轻和临床治愈率。临床治愈是根据美国食品和药物管理局(FDA)的四项症状和尿中没有可见血的分数的总和来定义的。结果:264例疑似cUTI患者中，146例(55.4%)为纯非e型。大肠杆菌感染(115例治疗，31例未经治疗)和190例(72%)多微生物感染(162例治疗，28例未经治疗)。在第14天，与未治疗的患者相比，接受治疗的患者表现出更大的症状减轻。大肠杆菌(3.18 vs 1.64, p = 0.006)和多微生物感染(3.52 vs 1.41, p = 0.002)。治疗组患者在第14天临床治愈多微生物感染的比例高于未治疗组(58.7% vs 36.4%， p = 0.049)。结论:基于M-PCR/P-AST诊断试验治疗的cUTIs患者与未治疗的cUTIs患者相比，症状减轻和临床治愈率显著提高。大肠杆菌或多种微生物感染。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Research and Reports in Urology UROLOGY & NEPHROLOGY-

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

16 weeks

期刊介绍： Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.