Clinical effectiveness of point of care tests for diagnosing urinary tract infection: a systematic review

Abstract

Background: Point of care tests (POCTs) have the potential to improve the urinary tract infection (UTI) diagnostic pathway, as they can provide a diagnosis quickly in near-patient settings, and some also identify causative pathogens/antimicrobial sensitivity.

Objectives: To assess the clinical impact, accuracy, and technical characteristics of POCT for diagnosing UTI.

Methods of data synthesis: Narrative summary and bivariate random effects meta-analyses to estimate summary sensitivity and specificity.

Data sources: Five electronic databases, two clinical trial registries, study reports and review reference lists, and websites.

Study eligibility criteria: Randomized controlled trials/non-randomized studies and diagnostic test accuracy studies published since 2000.

Participants: People with suspected UTI.

Tests: Rapid tests (results <40 minutes): Astrego PA-100 system, Lodestar DX, Uriscreen, UTRiPLEX. Culture tests (results <24 hours): Flexicult Human, ID Flexicult, Diaslide, Dipstreak, Chromostreak, Uricult, Uricult Trio, Uricult Plus.

Reference standard: Any.

Assessment of risk of bias: Risk of Bias-2, Quality Assessment of Diagnostic Accuracy Studies-2, Quality Assessment of Diagnostic Accuracy Studies-C.

Results: Two randomized controlled trials evaluated Flexicult Human (one against standard care; one against ID Flexicult). No difference was reported in antibiotic use concordant with culture results (OR 0.84 95% CI 0.58-1.20) or appropriate antibiotic prescribing (OR 1.44 95% CI 1.03-1.99). Initial antibiotic prescribing was lower with Flexicult than standard care (OR 0.56 95% CI 0.35-0.88). No difference for other measures of antibiotic use, symptom duration, patient enablement, or resource use. Fifteen studies reported accuracy data. Limited data were available, with most POCT evaluated in single studies or not evaluated at all. Uriscreen (four studies), Uricult Trio (three studies), Flexicult Human (four studies), and ID Flexicult (two studies) had modest sensitivity and specificity. POCTs were easier to use and interpret than standard culture.

Conclusions: There is currently insufficient evidence to support the use of POCTs in UTI diagnosis. Due to the rapid development of POCT, this review should be updated regularly.

Keywords: Antibacterial agents; Diagnostic test accuracy; Meta-analysis; Systematic review; Urinary tract infections.