Executive Summary
- We recommend against the routine use of urine polymerase chain reaction (PCR) testing for the diagnosis of urinary tract infection (UTI)
- Evidence supporting urine PCR is often biased because of funding sources, and there is no objective evidence of patient benefit
- Urine PCR testing likely will lead to unnecessary antibiotic use, which drives antimicrobial resistance
Antibiotic stewardship programs should use the CDC’s Core Elements of Antibiotic Stewardship for Nursing Homes as a framework to engage with the multidisciplinary team when making decisions on urine testing
Testing and treatment of urinary tract infections (UTIs) represent a frequent clinical challenge in post-acute and long-term care (PALTC) settings.1 Inappropriate urine testing is often driven by concerns about missing an infection and misconceptions about the significance of nonspecific symptoms.1,2 When ordered in the absence of clinical signs and symptoms of a UTI, these results are frequently misinterpreted as indicative of infection, leading to unnecessary antibiotic prescribing.1,2 This practice puts patients at risk of significant harms, including Clostridium difficile infections and antibiotic resistance.1,2 Furthermore, more than half of antibiotics prescribed in PALTC settings for UTI are considered inappropriate.1
Urine polymerase chain reaction (PCR) is a multiplex molecular testing method that uses pathogen-specific primers to identify a microbiological target within the urine sample. Marketed to PALTC settings as a faster and superior alternative to standard urine culture,3 its use has risen sharply, with billing claims increasing by more than 60-fold since 2016 with the highest growth among nursing home residents.4 Several factors including increasing use of urine PCR testing, emerging literature on its antimicrobial and diagnostic stewardship implications,4-7 and clinical scenarios such as the one outlined in Table 1 prompted the Infection Advisory Subcommittee of the Post-Acute and Long-Term Care Medical Association (PALTmed) to evaluate the role of urine PCR testing within current best practices.