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Clinicians are well aware of the limitations of the so-called Kass criteria applied to standard urine culture (SUC) techniques as well as the limitations of empiric antibiotic prescribing for symptoms that are known to overlap with chronic conditions such as overactive bladder, chronic pelvic pain and myofascial pelvic pain. Recent research has advanced next generation sequencing and enhanced quantitative urine culture (EQUC) methods to provide compelling evidence that urine contains microbes that SUC sporadically or cannot detect. In fact, EQUC can detect microbes in up to ~90% of urines deemed ‘no growth’ on SUC. This is the first randomised controlled trial (RCT) using EQUC, and is timely. It asked the question whether EQUC better predicted response to antibiotic therapy in women with urinary tract infection compared to SUC. Of 225 adult women with symptoms suggestive of urinary tract infection (UTI), 215 provided primary outcome data. 64% and 69% women from the SUC and EQUC groups respectively reported resolution of symptoms. There was no difference in symptom resolution for infections caused by Escherichia coli vs non-E. coli bacteria. As the editorial comment following the publication points out, the clinical value of sophisticated bacterial detection strategies to direct therapy in patients with recurrent or chronic cystitis symptoms with negative, non-E.coli or nebulous standard urine culture results remains to be answered.

A randomized clinical trial of standard versus expanded cultures to diagnose urinary tract infections in women.
Barnes HC, Wolff B, Abdul-Rahim O, et al.
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Jay Khastgir

Princess of Wales Hospital, Bridgend & Swansea University School of Medicine.

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