Infection and Drug Resistance (May 2023)

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

  • Korman HJ,
  • Mathur M,
  • Luke N,
  • Wang D,
  • Zhao X,
  • Levin M,
  • Wenzler DL,
  • Baunoch D

Journal volume & issue
Vol. Volume 16
pp. 2841 – 2848

Abstract

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Howard J Korman,1 Mohit Mathur,2 Natalie Luke,2 Dakun Wang,3 Xihua Zhao,4 Michael Levin,1 David L Wenzler,1 David Baunoch5 1Comprehensive Urology Division, Michigan Healthcare Professionals, Royal Oak, MI, USA; 2Department of Medical Affairs, Pathnostics, Irvine, CA, USA; 3Department of Writing, Stat4Ward, Pittsburgh, PA, USA; 4Department of Statistical Analysis, Stat4Ward, Pittsburgh, PA, USA; 5Department of Research and Development, Pathnostics, Irvine, CA, USACorrespondence: Mohit Mathur, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA, Email [email protected]: 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

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