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

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Conference Proceeding

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Journal of Urology


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





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