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Journal Article
New and developing diagnostic technologies for urinary tract infections
2017
Overview
Key Points
UTIs are increasingly caused by multidrug-resistant organisms as a result of the overuse of empirical, broad-spectrum antibiotic therapy
Antimicrobial susceptibility, determined by the phenotypic response to antibiotic exposure, is key for clinical decision making for treating the wide variety of uropathogens and identifying resistance markers
Existing technologies (such as PCR, fluorescence
in situ
hybridization, and mass spectrometry) and new technologies (such as droplet microfluidic and biosensor platforms) need to focus on direct urine testing to expedite objective diagnoses
Integrated biosensor–microfluidic platforms have the most potential for point-of-care testing, as they facilitate direct urine analysis and can encompass all assay steps in a compact device
New technologies are a key step towards improved antimicrobial stewardship
Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs and antimicrobial stewardship. In this Review, Davenport and colleagues discuss emerging technologies including biosensors, microfluidics, and other integrated platforms that could improve UTI diagnosis and treatment choice.
Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs. Urine dipsticks are fast and amenable to point-of-care testing, but do not have adequate diagnostic accuracy or provide microbiological diagnosis. Urine culture with antimicrobial susceptibility testing takes 2–3 days and requires a clinical laboratory. The common use of empirical antibiotics has contributed to the rise of multidrug-resistant organisms, reducing treatment options and increasing costs. In addition to improved antimicrobial stewardship and the development of new antimicrobials, novel diagnostics are needed for timely microbial identification and determination of antimicrobial susceptibilities. New diagnostic platforms, including nucleic acid tests and mass spectrometry, have been approved for clinical use and have improved the speed and accuracy of pathogen identification from primary cultures. Optimization for direct urine testing would reduce the time to diagnosis, yet these technologies do not provide comprehensive information on antimicrobial susceptibility. Emerging technologies including biosensors, microfluidics, and other integrated platforms could improve UTI diagnosis via direct pathogen detection from urine samples, rapid antimicrobial susceptibility testing, and point-of-care testing. Successful development and implementation of these technologies has the potential to usher in an era of precision medicine to improve patient care and public health.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Anti-Bacterial Agents - pharmacology
/ Anti-Bacterial Agents - therapeutic use
/ Bacteria
/ Biopsy
/ Clinical Laboratory Techniques - methods
/ Clinical Laboratory Techniques - trends
/ Drug Resistance, Bacterial - drug effects
/ Drug Resistance, Bacterial - physiology
/ Humans
/ Medical Laboratory Science - methods
/ Medical Laboratory Science - trends
/ Methods
/ Microfluidic Analytical Techniques - methods
/ Microfluidic Analytical Techniques - trends
/ Mutation
/ Polymerase Chain Reaction - methods
/ Polymerase Chain Reaction - trends
/ Prostate
/ Urinary Tract Infections - diagnosis
/ Urinary Tract Infections - drug therapy
/ Urinary Tract Infections - urine
/ Urine
/ Urology
