In this video, Roger R. Dmochowski, MD, MMHC, FACS, describes the next steps for PCR testing for urinary tract infection. He is senior author of the Neurology and Urodynamics study “Recurrent and complicated urinary tract infections in women: Utility of advanced testing to enhance care.” Dmochowski is professor of urology, surgery and gynecology and vice chair for faculty affairs and professionalism, and associate surgeon in chief at Vanderbilt University Medical Center in Nashville Tennessee.
It's interesting you asked that question because PCR testing has been available for urinary tract infections now for quite a while. But because of perhaps not ideal utilization, a couple of years ago, CMS actually put forward the current indication for PCR UTI testing as follows, "Patients or patients being symptomatic, and at higher risk for UTI complications (ie, the elderly patients with recurrent symptomatic urinary tract infections), or complicated urinary tract anatomy in the elderly or non elderly." So, these are patients who really should be the focus of advanced testing. Let's be honest, we've had the standard urinary tract culture and antibiotic resistance testing, ART, for essentially 50 to 60 years and have relied on that. But there is a 15% to 20% false negative rate associated with that, as we now know that patients can have very low colony counts of bacteria. And we're seeing the emergence of species that were not previously known or thought to be consistent with urinary tract infection arising from the evolution of the urinary tract microbiome, which we could spend hours talking about in terms of what's being identified as both normal and abnormal in the urinary tract. But what's key is the identification of a symptomatic patient who is not responding to therapy or who may present with a complicated presentation, at least as far as the federal government is concerned. And I do believe that policy does reflect good care. For the uncomplicated patient or the first-time patient, certainly a standard urinary tract culture with antibiotic resistance testing is reasonable. However, when we deal with patients with recurrence, specifically multiple recurrences, and patients with complicated presentations, then we should at least start thinking about perhaps advanced modalities such as PCR, if we're seeing patients who are either not responding to appropriate therapy, or present with these relatively not very unique and very common presentations with complications such as immunosuppression, for example.
This transcription was edited for clarity.