The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical Outcomes
Clinical success in treating complicated urinary tract infections (cUTIs) depends on accurate pathogen detection, given the common occurrence of polymicrobial infections and antimicrobial resistance. This multicenter, randomized, investigator-blinded study compared polymerase chain reaction (PCR)-ba...
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2025-04-01
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| author | Moustafa Kardjadj Tara W. Chang Roel Chavez DeAndre Derrick Frank L. Spangler Itoe P. Priestly Lauren Y. Park Thomas K. Huard |
| author_facet | Moustafa Kardjadj Tara W. Chang Roel Chavez DeAndre Derrick Frank L. Spangler Itoe P. Priestly Lauren Y. Park Thomas K. Huard |
| author_sort | Moustafa Kardjadj |
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| description | Clinical success in treating complicated urinary tract infections (cUTIs) depends on accurate pathogen detection, given the common occurrence of polymicrobial infections and antimicrobial resistance. This multicenter, randomized, investigator-blinded study compared polymerase chain reaction (PCR)-based diagnostics to conventional culture and sensitivity (C&S) testing in guiding the treatment of cUTIs. PCR identified polymicrobial infections in 43.52% of cases, a significantly higher rate than that observed with C&S (31.95%, <i>p</i> = 0.033). Patients in the C&S arms with undetected polymicrobial infections had a significantly higher clinical failure rate (33.33%, 14/42, <i>p</i> = 0.041) compared to those with concordant polymicrobial infection identification by both methods (22.22%, 12/54). PCR also detected additional pathogens in 54.44% (92/169) of cases in the C&S arm, where clinical failure was significantly higher when C&S missed pathogens (28.26% vs. 14.29%, <i>p</i> = 0.015). Similarly, when C&S failed to detect phenotypic resistance (compared to PCR), clinical failure occurred in 50% (16/42) of cases, compared to 13.22% (21/121, <i>p</i> = 0.001) when resistance detection was concordant (PCR and C&S). To further illustrate the clinical impact, patient-level case analyses are included to demonstrate how PCR-guided therapy improved pathogen detection and enabled more appropriate antimicrobial selection compared to C&S. These findings highlight the limitations of C&S in detecting polymicrobial infections, antimicrobial resistance, and hetero-resistance due to its limited clonal analysis, supporting the integration of PCR for more accurate diagnostics and optimized cUTI management. |
| format | Article |
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| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
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| series | Microorganisms |
| spelling | doaj-art-9f5ccb296a424974a17fe67f98d8d88c2025-08-20T02:28:15ZengMDPI AGMicroorganisms2076-26072025-04-0113494910.3390/microorganisms13040949The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical OutcomesMoustafa Kardjadj0Tara W. Chang1Roel Chavez2DeAndre Derrick3Frank L. Spangler4Itoe P. Priestly5Lauren Y. Park6Thomas K. Huard7dicentra, Toronto, ON M4W 3E2, CanadaAlbany Urology Clinic & Surgery Center, Albany, GA 31707, USADoc Lab Inc., Hillsboro, OR 97006, USADoc Lab Inc., Hillsboro, OR 97006, USASoft Cell Laboratories, St. George, UT 84770, USASoft Cell Laboratories, St. George, UT 84770, USAdicentra, Toronto, ON M4W 3E2, CanadaMED-US Consulting, LLC., Austin, TX 78734, USAClinical success in treating complicated urinary tract infections (cUTIs) depends on accurate pathogen detection, given the common occurrence of polymicrobial infections and antimicrobial resistance. This multicenter, randomized, investigator-blinded study compared polymerase chain reaction (PCR)-based diagnostics to conventional culture and sensitivity (C&S) testing in guiding the treatment of cUTIs. PCR identified polymicrobial infections in 43.52% of cases, a significantly higher rate than that observed with C&S (31.95%, <i>p</i> = 0.033). Patients in the C&S arms with undetected polymicrobial infections had a significantly higher clinical failure rate (33.33%, 14/42, <i>p</i> = 0.041) compared to those with concordant polymicrobial infection identification by both methods (22.22%, 12/54). PCR also detected additional pathogens in 54.44% (92/169) of cases in the C&S arm, where clinical failure was significantly higher when C&S missed pathogens (28.26% vs. 14.29%, <i>p</i> = 0.015). Similarly, when C&S failed to detect phenotypic resistance (compared to PCR), clinical failure occurred in 50% (16/42) of cases, compared to 13.22% (21/121, <i>p</i> = 0.001) when resistance detection was concordant (PCR and C&S). To further illustrate the clinical impact, patient-level case analyses are included to demonstrate how PCR-guided therapy improved pathogen detection and enabled more appropriate antimicrobial selection compared to C&S. These findings highlight the limitations of C&S in detecting polymicrobial infections, antimicrobial resistance, and hetero-resistance due to its limited clonal analysis, supporting the integration of PCR for more accurate diagnostics and optimized cUTI management.https://www.mdpi.com/2076-2607/13/4/949urinary tract infectionpolymerase chain reactionmicrobial sensitivity testsantimicrobial drug resistancepolymicrobial infectionsmolecular diagnostic testing |
| spellingShingle | Moustafa Kardjadj Tara W. Chang Roel Chavez DeAndre Derrick Frank L. Spangler Itoe P. Priestly Lauren Y. Park Thomas K. Huard The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical Outcomes Microorganisms urinary tract infection polymerase chain reaction microbial sensitivity tests antimicrobial drug resistance polymicrobial infections molecular diagnostic testing |
| title | The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical Outcomes |
| title_full | The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical Outcomes |
| title_fullStr | The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical Outcomes |
| title_full_unstemmed | The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical Outcomes |
| title_short | The Clinical Validity and Utility of PCR Compared to Conventional Culture and Sensitivity Testing for the Management of Complicated Urinary Tract Infections in Adults: A Secondary (Ad Hoc) Analysis of Pathogen Detection, Resistance Profiles, and Impact on Clinical Outcomes |
| title_sort | clinical validity and utility of pcr compared to conventional culture and sensitivity testing for the management of complicated urinary tract infections in adults a secondary ad hoc analysis of pathogen detection resistance profiles and impact on clinical outcomes |
| topic | urinary tract infection polymerase chain reaction microbial sensitivity tests antimicrobial drug resistance polymicrobial infections molecular diagnostic testing |
| url | https://www.mdpi.com/2076-2607/13/4/949 |
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