Multiplex Polymerase Chain Reaction/Pooled Antibiotic Susceptibility Testing Was Not Associated with Increased Antibiotic Resistance in Management of Complicated Urinary Tract Infections

Abstract

Objective

To compare antibiotic resistance results at different time points in patients with urinary tract infections (UTIs), who were either treated based upon a combined multiplex polymerase chain reaction (M-PCR) and pooled antibiotic susceptibility test (P-AST) or were not treated.

Methods

The M-PCR/P-AST test utilized here detects 30 UTI pathogens or group of pathogens, 32 antibiotic resistance (ABR) genes, and phenotypic susceptibility to 19 antibiotics. We compared the presence or absence of ABR genes and the number of resistant antibiotics, at baseline (Day 0) and 5–28 days (Day 5–28) after clinical management in the antibiotic-treated (n = 52) and untreated groups (n = 12).

Results

Our results demonstrated that higher percentage of patients had a reduction in ABR gene detection in the treated compared to the untreated group (38.5% reduction vs 0%, p = 0.01). Similarly, significantly more patients had reduced numbers of resistant antibiotics, as measured by the phenotypic P-AST component of the test, in the treated than in the untreated group (42.3% reduction vs 8.3%, p = 0.04).

Conclusion

Our results with both resistance gene and phenotypic antibiotic susceptibility results demonstrated that treatment based upon rapid and sensitive M-PCR/P-AST resulted in reduction rather than induction of antibiotic resistance in symptomatic patients with suspected complicated UTI (cUTI) in an urology setting, indicating this type of test is valuable in the management of these types of patients. Further studies of the causes of gene reduction, including elimination of ABR gene-carrying bacteria and loss of ABR gene(s), are warranted.

Keywords:

• urinary tract infection
• complicated urinary tract infection
• antibiotic resistance
• antibiotic resistance genes
• diagnostic testing
• polymerase chain reaction

Data Sharing Statement

All relevant data are present within the manuscript text and tables.

Ethics Approval and Consent to Participate

All patients provided verbal informed consent (Western IRB 20214705) prior to enrollment.

Disclosure

D.B., N.L., and M.M. are employees of Pathnostics, and HJK, D. Wa. and X.Z. are paid consultants for Pathnostics. Dr Natalie Luke reports grants from Thermofisher, during the conduct of the study. In addition, Dr Natalie Luke has a patent US 10,160,991 issued to Pathnostics, a patent US 11,053,532 issued to Pathnostics, a patent US 17/178,091 pending to Pathnostics, a patent US 17/335,767 pending to Pathnostics, a patent US 17/830,227 pending to Pathnostics, a patent PCT/US22/16816 pending to Pathnostics, a patent PCT/US22/77477 pending to Pathnostics, a patent AU 2018254514 B2 issued to Pathnostics, a patent BR112019021943-9 B1 issued to Pathnostics, a patent NZ 759292 issued to Pathnostics, a patent EP 3612638 pending to Pathnostics, a patent JP 2020-507493 pending to Pathnostics, a patent JP 2022-042545 pending to Pathnostics, a patent CA 3,175,879 pending to Pathnostics, a patent CA 3,176,586 pending to Pathnostics, a patent CA 3,061,015 pending to Pathnostics, a patent HK 62020014337.3 pending to Pathnostics, a patent CN 201880039956.9 pending to Pathnostics, a patent IL 294577 pending to Pathnostics. Dr David L Wenzler reports grants, personal fees from Pathnostics, during the conduct of the study. Dr David Baunoch reports a patent US 10,160,991 issued to PATHNOSTICS, a patent US 11,053,532 issued to PATHNOSTICS, a patent US 17/178,091 pending to PATHNOSTICS, a patent US 17/830,227 pending to PATHNOSTICS, a patent US 17/335/767 pending to PATHNOSTICS, a patent PCT/US22/16816 pending to PATHNOSTICS, a patent PCT/US22/77477 pending to PATHNOSTICS, a patent AU 2018254514 B2 issued to PATHNOSTICS, a patent BR112019021943-9 B1 issued to PATHNOSTICS. The authors report no other conflicts of interest in this work.

Additional information

Funding

Pathnostics and Thermo Fisher funded the study.