Clinical Utility of Polymerase Chain Reaction in Evaluation of Patients With Symptomatic Recurrent and/or Complicated Urinary Tract Infection

Document Type

Conference Proceeding

Publication Date

4-2023

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Patients with recurrent and/or complicated urinary tract infection (RCUTI) have higher risk of complications and present with broader microbial spectrum, and may present with polymicrobial UTI and/or fastidious organisms (pmUTI/FO).Urine culture (UC) has substantial false negative (neg) rates and poorly detects pmUTI/FO. Data suggests that polymerase chain reaction(PCR) enhances urinary pathogen detection and identification of pmUTI/FO. We sought to ascertain if there was a difference in overall pathogen and pmUTI/FO detection between UC and PCR in our patients seen with symptomatic RCUTI. METHODS: Our clinical guidelines recommend PCR testing only in RCUTI; in 2022 3,395 patients such patients who received concomitant UC and PCR were reviewed. Tests were performed by P4Diagnostix (Pine Brook, NJ). UC plates were inspected after 18-42 hours incubation for colony growth, quantity, and morphology. DNA extraction and amplification for 36-organism PCR analysis was performed using KingFisher Flex and QuantStudio 12K Flex Real Time PCR System. For our RCUTI population positive (pos) UC was defined as single organism growth of >10k CFU/ml while pos PCR were organisms detected at a cycle threshold <29. Statistical analysis was performed using Chi square and two-way ANOVA test. This IRB-exempt study was conducted in accordance with the Declaration of Helsinki. RESULTS: Patient mean age was 69.6 yrs (range 6-99) with1,808 males (53%) and 1,587 females (47%). Pathogen and pmUTI/FO detection was greater for PCR than UC (Table 1). 1490/1569 (95%) of pos UC had pos PCR; PCR revealed pmUTI/FO in 1003/1490 (67%) of these. PCR showed pathogens in 641/1826 (35%) of neg UC while UC revealed pathogens in 79/1264 (6%) of neg PCR (D29%, p<.01); pmUTI/FO were seen in 501/641 (78%) in patients with pos PCR/negUC. 33/79 (42%) of pos UC/neg PCR results were organisms not on the PCR panel. CONCLUSIONS: Organism detection was significantly greater for PCR than UC in patients with RCUTI. Detection of pmUTI/FO was augmented by PCR in both positive and negative UC but 33 potentially clinically relevant pathogens were outside even a 36 organism panel. UC and PCR provided complementary data that may help guide treatment of RCUTI and improve clinical outcomes for this subset of patients

Volume

209

Issue

4S

First Page

e1179

Last Page

e1180

Comments

American Urological Association Annual Meeting, April 28 - May 1, 2023, Chicago, IL

DOI

10.1097/JU.0000000000003360.09

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