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Howard J Korman,1 David Baunoch,2 Natalie Luke,2 Dakun Wang,3 Xihua Zhao,4 Michael Levin,1 David L Wenzler,1 Mohit Mathur5 1Comprehensive Urology Division, Michigan Healthcare Professionals, Royal Oak, MI, USA; 2Department of Research and Development, Pathnostics, Irvine, CA, USA; 3Department of Writing, Stat4Ward, Pittsburgh, PA, USA; 4Department of Statistical Analysis, Stat4Ward, Pittsburgh, PA, USA; 5Department of Medical Affairs, Pathnostics, Irvine, CA, USACorrespondence: Mohit Mathur, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA, Email mmathur@pathnostics.comPurpose: 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 patientsâ 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.Keywords: urinary tract infection, complicated urinary tract infection, antibiotic, clinical outcome, diagnostic testing, polymerase chain reaction |
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