On March 21, the UK’s National Institute for Health and Clinical Excellence (NICE) released draft recommendations for the use of point-of-care testing to improve antimicrobial prescribing for urinary tract infections (UTIs). The potential benefits of rapid diagnostics have been highlighted, but further data on test accuracy is needed before they can be utilized in the National Health Service (NHS). Final approval of the recommendations is set for May 4, 2023. The new tests, which are not currently recommended for routine use in healthcare settings, may be reconsidered if evidence of their effectiveness is provided. Public consultation will continue until the end of March.
The use of point-of-care testing to improve antimicrobial prescribing for UTIs could potentially revolutionize the way that such infections are diagnosed and treated. The NICE report identified four tests that show promise in providing results within an hour and can be performed by healthcare professionals outside of a laboratory in a primary care setting. Developers of the technology claim that they can determine the presence of bacteria in a urine sample in less than 15 minutes. Within 40 minutes, it is possible to determine the presence of the six most common uropathogens in the urine or the sensitivity of pathogens to the five most commonly prescribed antibiotics.
The current process for diagnosing UTIs involves a combination of clinical symptoms, test strips, and laboratory tests, with the sensitivity of the microflora taking up to 72 hours to determine. In contrast, the new point-of-care tests offer rapid results that could enable healthcare professionals to quickly and accurately determine whether antibiotic therapy is warranted. This would help to rationalize the use of antibiotics in UTIs, reducing the risk of antibiotic resistance and other complications associated with incorrect prescribing.
The need for improved UTI diagnostics is clear from the NICE report, which indicates that 1/5 of all antibiotics prescribed in England in 2019-2020 were used for lower UTIs. This highlights the importance of reducing unnecessary antibiotic use in these infections, as incorrect diagnosis or prescribing of an ineffective antibiotic can lead to chronic pathology and sepsis.
While the potential benefits of point-of-care testing are promising, further research is needed to determine their clinical and cost-effectiveness. The TOUCAN trial, for example, is already underway to investigate the use of rapid diagnostics in UTIs. The expert committee will reconvene to review the evidence and potentially revise the recommendations if appropriate.
It is important to note that the NICE recommendations are not a ban on the use of point-of-care tests for UTIs, but rather a call for caution until more data on their accuracy and effectiveness is available. This approach reflects the need to balance the potential benefits of rapid diagnostics with the need for evidence-based prescribing and the reduction of antibiotic resistance.
In conclusion, the potential benefits of point-of-care testing for UTIs are clear, but more evidence is needed to support their use in the NHS. The NICE recommendations provide guidance on the use of these tests and call for further research to determine their clinical and cost-effectiveness. As the global issue of antibiotic resistance continues to grow, the development of effective and accurate diagnostic tools is more important than ever, and the potential benefits of point-of-care testing for UTIs could be significant in addressing this challenge.