Rethinking UTI Diagnostics: The Case for Rapid, Culture-Independent Testing
This review critiques the limitations of standard urine culture, which misses fastidious and anaerobic uropathogens, rarely reports polymicrobial infections, and takes over 24 hours. The authors survey emerging rapid diagnostic approaches including molecular assays and biosensors capable of delivering clinically useful results within hours, while highlighting newly recognised uropathogens overlooked by conventional techniques. The persistent gap between negative cultures and urinary symptoms underscores the need for next-generation diagnostic platforms that support timely antimicrobial stewardship.
The original study
Rapid and accurate testing for urinary tract infection: new clothes for the emperor.
- Authors
- Moreland RB, Brubaker L, Tinawi L, Wolfe AJ
- Journal
- Clinical microbiology reviews
- Type
- Journal Article, Review
- PMID
- 39641639
Original abstract
SUMMARYUrinary 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. In other cases, UTI resolves without treatment. Clinical diagnosis is typically based on patient symptoms and/or urinalysis, including urine dipsticks. The standard urine culture method is sometimes employed to identify the suspected urinary pathogen (uropathogen) and/or guide antimicrobial choice, but results are rarely available before 24 h. The standard urine culture method also misses fastidious, anaerobic, and slow-growing uropathogens and rarely reports polymicrobial infections. The unexplained combination of negative urine cultures with persistent urinary tract symptoms is distressing to both patients and clinicians. Given the broad appreciation of the advantages provided by rapid testing (e.g., for COVID-19 or influenza A), a rapid, accurate diagnostic test is needed to deliver timely treatment to patients seeking care for UTI that optimizes antibiotic stewardship. Herein, we discuss progress being made toward an accessible, timely (i.e., within hours), accurate assay with results that are clinically useful for the treating clinician within the timeframe of the infection (i.e., the growth rate of the pathogen(s)). New and emerging uropathogens often overlooked by current diagnostic techniques are also reviewed.