Combatting AMR with Rapid UTI Diagnostics
Combatting AMR with Rapid UTI Diagnostics
Antimicrobial Resistance Awareness Week: Combatting AMR with Rapid UTI Diagnostics
Antimicrobial Resistance (AMR) poses one of the most critical health challenges of our time. Indeed, the World Health Organisation (WHO) has identified AMR as one of the top 10 global health threats (1). Furthermore, in the UK, AMR is recognised on the National Risk Register (2), reflecting the severity of the issue at both national and international levels. With AMR-related deaths reaching 4.95 million globally in 2019 (1), including 1.27 million directly attributed to resistant infections (1), urgent and coordinated action is required to preserve the efficacy of existing antimicrobials.
As part of Antimicrobial Resistance Awareness Week (18–24 November), we are focusing on the critical role of rapid diagnostics in combating AMR. Specifically, we are introducing the Randox Vivalytic UTI Rapid Test as a valuable tool in this global effort. By enabling faster and more accurate detection of infections, this innovative diagnostic technology supports the targeted use of antibiotics, thereby helping to reduce unnecessary prescriptions and mitigate the spread of resistance.
Understanding AMR: The Need for Effective Screening and Targeted Treatment
AMR develops when microorganisms such as bacteria, viruses, fungi, and parasites evolve to resist the effects of antimicrobial medicines. While this resistance occurs naturally, it is significantly accelerated by factors such as the overuse and misuse of antibiotics, poor infection control, and the slow pace of new antimicrobial drug development. Consequently, the implications of AMR extend far beyond infection treatment: surgeries, cancer therapies, and routine medical procedures also rely heavily on effective antimicrobials to prevent infections. Therefore, this underscores the pressing need to manage resistance effectively and proactively.
For instance, routine treatments for UTIs heavily depend on antibiotics. UTIs are among the most common bacterial infections, particularly affecting women, with over 50% experiencing a UTI at least once in their lives (3). However, with resistance levels increasing, it becomes crucial to avoid unnecessary antibiotic prescriptions. Additionally, when antibiotics are prescribed, they must be carefully targeted to maximise efficacy and minimise resistance development. In this context, rapid diagnostics play a pivotal role by enabling precise and timely identification of infections, which ensures that treatments are both effective and appropriate.
Introducing the Vivalytic UTI Rapid Test
The Randox Vivalytic UTI Rapid Test offers a cutting-edge solution for the efficient screening and diagnosis of UTIs. Unlike traditional culture methods—which, according to a recent study, take an average of 2.75 days to yield results (4)—the Vivalytic UTI Rapid Test is a cartridge-based PCR test specifically designed for in-clinic use, delivering results in just 2.5 hours. This rapid turnaround is transformative in the management of UTIs, where timely diagnosis is crucial to preventing the progression of infections. Moreover, it helps to minimise unnecessary antibiotic use by ensuring treatment is both prompt and precisely targeted, ultimately supporting the fight against antimicrobial resistance.
Key Features of the Vivalytic UTI Rapid Test:
- Comprehensive Detection: The Vivalytic UTI Rapid Test identifies 16 uropathogens, encompassing both gram-negative and gram-positive bacterial species, in just 150 minutes—significantly faster than traditional culture methods.
- AMR Gene Identification: This advanced test also detects 7 antimicrobial resistance genes, including those conferring resistance to methicillin (mecA) and vancomycin (vanA and vanB), as well as genes associated with trimethoprim resistance (dfrA1, dfrA5, dfrA12, dfrA17). This capability supports targeted treatment decisions and helps in combating antimicrobial resistance.
- Wide Application: Designed for versatility, the test is suitable for various healthcare settings, from GP practices to hospitals. It facilitates UTI diagnosis across diverse use cases, including catheter-associated UTIs and pre-surgical screenings for patients with conditions such as benign prostatic hyperplasia (BPH) or renal stones.
Additionally, a recent study demonstrated that the Vivalytic UTI Rapid Test achieved diagnostic accuracy exceeding 90% for 16 bacterial species, providing a reliable and efficient solution for rapid pathogen identification in UTI cases (4).
The Role of Rapid Diagnostics in Combating AMR
Rapid diagnostic tests, such as the Vivalytic UTI Rapid Test, play a critical role in addressing antimicrobial resistance (AMR) and improving patient care through the following:
- Reducing Misuse of Antibiotics: By rapidly identifying the specific bacteria responsible for the infection and detecting resistance genes, clinicians can prescribe antibiotics only when necessary. This targeted approach ensures that the most effective treatment is selected, helping to combat antibiotic misuse.
- Supporting Antimicrobial Stewardship: Point-of-care testing directly supports the goals outlined in the UK’s AMR 5-Year National Action Plan, which aims to reduce antibiotic consumption by 5% and ensure that 70% of antibiotics are sourced from safer, first-line options (5). Rapid tests enable optimised antibiotic usage, contributing to these national targets and the broader fight against AMR.
- Enhancing Patient Outcomes: Faster and more accurate diagnostics at the point of care enable timely and targeted treatment, reducing the risk of complications such as severe UTI-related kidney infections. Furthermore, a study on the Vivalytic UTI Rapid Test demonstrated that pathogen detection rates were slightly higher when tests were conducted immediately on-site, underscoring the importance of rapid diagnostics in delivering better patient outcomes (4).
AMR and the Future of Healthcare
The rise in AMR jeopardises the future of modern medicine. An estimated 10 million lives could be lost per year by 2050 (6), according to a review commissioned by the UK Prime Minister. Without effective diagnostics and treatments, procedures such as hip replacements, caesarean sections, and cancer therapies could become significantly more dangerous. This is due to the heightened risk of untreatable infections (1). Addressing this escalating threat requires innovation, education, and unwavering commitment.
AMR also imposes immense economic consequences. The World Bank projects that by 2050, AMR could add an extra US$1 trillion to global healthcare costs. It may also cause annual GDP losses ranging from US$1 trillion to US$3.4 trillion as early as 2030 (7). These economic burdens highlight the urgent need for global action.
Addressing AMR is crucial to achieving the Sustainable Development Goals (SDGs) outlined by the United Nations (UN). Progress in areas such as access to clean water, sustainable food production, and responsible antimicrobial use is vital in mitigating AMR. However, rising levels of AMR exacerbate challenges related to health, poverty reduction, food security, and economic growth (8). Coordinated efforts across multiple sectors are essential to tackle this complex issue effectively.
Randox is proud to lead the charge in the fight against antimicrobial resistance (AMR), equipping healthcare professionals with innovative tools such as the Vivalytic UTI Rapid Test. By enabling timely and accurate diagnoses, we contribute to preserving the efficacy of antimicrobials and safeguarding their availability for future generations.
This Antimicrobial Resistance Awareness Week, join us in highlighting the critical importance of AMR management and the transformative role of rapid diagnostics in creating a safer, healthier future for all.
Learn more about the urgency of AMR on the WHO website: Antimicrobial resistance.
For further details about the Vivalytic UTI Rapid Test, visit Vivalytic | UTI Rapid Test | Randox Laboratories or reach out to us at marketing@randox.com.
References
- World Health Organization (2023). Antimicrobial resistance. [online] World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
- HM Government (2023). National Risk Register 2023 Edition. [online] Available at: https://assets.publishing.service.gov.uk/media/64ca1dfe19f5622669f3c1b1/2023_NATIONAL_RISK_REGISTER_NRR.pdf.
- Bono MJ, Reygaert WC. Urinary Tract Infection. Nih.gov. Published 2018. https://www.ncbi.nlm.nih.gov/books/NBK470195/
- Hartmann, J., Fritzenwanker, M., Imirzalioglu, C., Hain, T., Arneth, B.M., and Wagenlehner, F.M.E., 2024. Point-of-care Testing in Complicated Urinary Tract Infection: Evaluation of the Vivalytic One Urinary Tract Infection Analyser for Detecting Uropathogenic Bacteria and Antimicrobial Resistance in Urine Samples of Urological Patients in a Point-of-care Setting. European Urology Focus. Available at: https://doi.org/10.1016/j.euf.2024.09.018
- Department of Health and Social Care (2024). UK 5-year action plan for antimicrobial resistance 2024 to 2029. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2024-to-2029.
- O’Neill, J. (2016). Tackling Drug-resistant Infections Globally: Final Report and Recommendations. Archives of Pharmacy Practice, 7(3), p.110. doi:https://doi.org/10.4103/2045-080x.186181.
- World Bank (2017). Drug-Resistant Infections: A Threat to Our Economic Future. [online] World Bank. Available at: https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future.
- World Health Organization (WHO) (2021). Antimicrobial resistance and the United Nations sustainable development cooperation framework: guidance for United Nations country teams. [online] www.who.int. Available at: https://www.who.int/publications/i/item/9789240036024.
Vivalytic | Urinary Tract Infection
Vivalytic | UTI Rapid Test
–
Rapid multiplex detection of common urinary tract infections
*Research Use Only
UTI testing made simple
- Quick turnaround time of 150 minutes compared to 72 hours minimum for standard urine culture, beneficial for both the patient and for the containment of the most common UTIs
- Convenient 4 step process from sample entry to results. Suitable for use in laboratory and non-laboratory settings
- Detect 16 different uropathogens and identify the presence of 7 antimicrobial resistance genes all from one single urine sample
Clinical Significance
Urinary tract infections (UTIs) are highly prevalent infections acquired both in the community and hospital settings. The widespread use of antibiotics has led to an alarming rise in UTIs caused by organisms that are resistant to multiple drugs, affecting approximately 150 million people worldwide each year.
UTIs can be categorised as either uncomplicated or complicated, depending on various factors such as anatomical or functional abnormalities within the urinary tract, comorbidities, recurrent UTIs, catheter-associated UTIs, and urosepsis.
A single native urine sample, along with the Vivalytic PCR-based assay, for simultaneous qualitative detection of causative UTI bacterial and fungal pathogens can detect 16 different uropathogens and identify the presence of 7 antimicrobial resistance genes, allowing for a swift and effective treatment plan to begin. With a rapid time-to-result of 2.5 hours and capable of identifying a multitude of bacterial targets, the UTI panel on Vivalytic leads to improved patient outcomes and effective management of urinary tract infections.
R&D project manager Dr Heather McMillan discusses the importance of diagnostics in the treatment of UTI’s.
Features
Sample Type: Native Urine
Sample Volume: 300 μl
Detection Method: Randox Biochip Technology (end-point PCR)
Time to result: 2.5 Hours
| Detectable Pathogens | ||
|---|---|---|
| GRAM-NEGATIVE BACTERIAL SPECIES | GRAM-POSITIVE BACTERIAL SPECIES | ANTIMICROBIAL RESISTANCE GENES |
| Acinetobacter baumannii | Enterococcus faecalis | TRIMETHOPRIM RESISTANCE |
| Enterobacter cloacae | Enterococcus faecium | dfrA1 |
| Escherichia coli | Staphylococcus aureus | dfrA5 |
| Klebsiella aerogenes | Staphylococcus epidermidis | dfrA12 |
| Klebsiella oxytoca | Staphylococcus saprophyticus | dfrA17 |
| Klebsiella pneumoniae | Streptococcus agalactiae | METHICILLIN RESISTANCEVANCOMYCIN RESISTANCE |
| Morganella morganii | mecA | |
| Proteus spp. | Vancomycin Resistance | |
| Providencia stuartii | vanA | |
| Pseudomonas aeruginosa | vanB | |
“AWARD-WINNING DESIGN DELIVERS
AN UNCOMPLICATED USER EXPERIENCE”
Vivalytic Workflow
Intuitive engineering of Vivalytic ensures the analyser is user friendly. The process of patient sample to result comprises a very simple 4 step workflow.
To begin the test, the user scans or enters sample information. The cartridge code is then scanned into the embedded Vivalytic software. The user then adds sample into the dedicated cartridge slot, closes the lid and inserts the cartridge into the Vivalytic.
The touchscreen display will countdown the time remaining to test completion. Results will be displayed on the screen. Multiple Vivalytics can be wirelessly connected allowing the user to control multiple tests at one time all reporting to a master Vivalytic platform.
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Diagnosing UTI Complications in Mothers and Newborns
Diagnosing UTI Complications in Mothers and Newborns
Urinary tract infections (UTIs) are one of the most common bacterial infections that occur in humans. Over 50% of women become infected with a UTI at least once in their lives, with up to 10% of women suffering from yearly infections5. Recurrence rates are high in UTIs, almost 50% of women who contract a UTI experience reinfection or relapse within one year of the initial infection5. Men are four times less likely to contract a UTI due to a longer urethra seen in men when compared with women.
Infections occur in the urinary organs and structures which can be categorized by the site of infection: cystitis (bladder), pyelonephritis (kidney) and bacteriuria (urine)5. So-called, uncomplicated UTIs are sited only in the bladder, however, UTIs are highly likely to cause secondary infections, commonly in the kidneys. Pyelonephritis has been shown to result in renal scarring and in some cases, subsequent renal failure2. There are various species of bacteria responsible for UTIs, which have different mechanisms of infection and virulence. However, most species have surface adhesins which function like hooks, attaching the bacteria to the urothelial mucosal surface, and colonizing the bladder. From here, the bacteria can ascend the ureters, reaching the kidney and causing secondary infections2.
Under normal conditions, the innate immune system actions an inflammatory response to the infection site. However, some species of bacteria that cause UTI can inhibit or delay the immune response resulting in secondary infections in the ureters and kidneys where the risk of severe renal defects is considerable, and the bacteria have direct access to the bloodstream2.
Common symptoms of UTI include:
- Frequent urination
- Painful urination
- Incomplete voiding of the bladder
- Pelvic, back, and/or abdominal pain
- Haematuria
- Lethargy
- Nausea and/or vomiting
- Fever
Antibiotic therapies are effective and aim to facilitate the immune response and inhibit the spread of the infection to the kidneys and upper urinary tract. Although these treatments are usually effective, antimicrobial resistance (AMR) has become a global crisis encompassing all medical disciplines3. This resistance to antibiotics can occur through several mechanisms such as dysregulation of protein expression, structural modifications, and mutations to name a few11.
Bacteria are capable of some level of intrinsic resistance, or insensitivity, to antibiotics through the production of various enzymes designed to degrade the drug or inhibit its mechanism11. Mutations found in the genome of bacterial species are often responsible for the resistance they display. These mutations commonly alter the bacterial binding sites used by antibiotics, therefore inhibiting their action. Some bacteria produce enzymes, which alter the chemical structure of the antibiotic, again, inhibiting them from binding to the antibiotic. Other examples include horizontal gene transfer and biofilm formation10.
One study reported in 2019, that AMR was the twelfth leading cause of death when compared with a susceptible infection counterfactual9. The same study went on to show that AMR had the highest mortality rate in low to middle-income countries providing evidence that AMR is an even bigger problem in the most impoverished parts of the world. New techniques such as CRISPR-Cas9 and antibiotic re-sensitization methods are at the forefront of the fight against AMR, however, the scale of the problem warrants taking all possible action to elevate the risk posed by AMR8.
UTI During Pregnancy
UTIs are a common occurrence in pregnancy with one hospital reporting over 15% of pregnant women being diagnosed with some form of UTI4. Diagnosis can usually be confirmed by a bacterial growth of over 105 counts/ml in urine4, 12, 13. Many hormonal and anatomical changes occur in a woman’s body during pregnancy that create favorable conditions for UTI. Firstly, the glomerular filtration rate is altered, causing an increase in glucose concentration and pH of the urine3. The urethral dilation, smooth muscle relaxation, enlarged mechanical compression of the uterus, and increased plasma volume result in lower urinary concentration and increased bladder size leading to urinary tract reflux and urine stagnation. These conditions are favorable for the proliferation of bacterial infections1.
Diagnosis of UTIs in pregnant women can be complicated. For example, the increased frequency of urination experienced could also be caused by additional pressure placed on the woman’s bladder by the baby, or the abdominal pain indicative of a UTI could be interpreted as Braxton Hicks contractions and vice versa3. There are several established risk factors associated with UTI in pregnancy including advanced maternal age, diabetes, sickle cell anemia, history of UTI, urinary tract abnormalities, and various immunodeficiencies3. Other reports claim that UTI in pregnancy is more common in women with hypothyroidism and women who are carrying their first child4.
Bacterial Species Responsible for UTI
There are a multitude of bacterial species responsible for UTIs, the most common is Escherichia coli (E. coli), followed by group B streptococcus (GBS), enterococcus, and Klebsiella pneumonia. Escherichia coli infections are categorized as either enteric or extraintestinal (ExPEC). Of the latter, there are two main culprits: neonatal meningitis E. coli (NMEC) and uropathogenic E. coli (UPEC)2. These infections can exist in the gut and spread, colonizing other parts of the host such as the blood or central nervous system, causing other potentially severe infections. Of these strains, UPEC is responsible for around 80% of both symptomatic and asymptomatic UTIs. UPEC strains have been associated with acute renal damage and are thought to encourage bacterial growth and persistence by inhibiting or delaying the innate immune response2.
Maternal and Perinatal UTI Complications
UTI complications in mothers and children have long been debated. However, there is sufficient evidence to support several prognostic claims. Preterm delivery is a major complication associated with UTI and has been well studied. Preterm neonates face a high risk of fatality with up to 1 million babies dying every year due to premature labor6. Those that survive are at risk of developing one or more of the following health defects1:
- Lung problems
- Diabetes
- Heart Disease
- Hearing loss
- Visual impairment
- Learning disabilities
- Behavioral problems
- Cerebral palsy
The risk of preterm birth in women who suffered from a single UTI was increased when compared to women who had no infection during their pregnancy but recurrent UTIs did not increase the risk3. Risk of low birth weight has been shown to increase by 50% in women who suffered symptomatic UTIs compared to those who remained uninfected throughout their pregnancy; this risk can be mitigated through antibiotic therapy. The same treatments did not show any significant ameliorative effects on preterm birth4. Women who contract a UTI during pregnancy are also at a higher risk of various conditions such as preeclampsia, postpartum endometritis, sepsis1, hypertensive disorders, anemia and amnionitis4.
Asymptomatic UTIs, also known as asymptomatic bacteriuria (ASB), are not known to cause as drastic primary effects on pregnancy as seen with symptomatic infections. Despite this, ASB can spread and colonize in the kidneys. At this point, pyelonephritis is likely to occur, increasing the risk of severe renal scarring4 and advanced risk of preterm birth3. In these cases, it is common to treat the patient with antibiotics to reduce the risk of a secondary, symptomatic infection. While these treatments are effective at limiting the progression of the infection, overuse of antibiotics is a primary factor contributing to antimicrobial resistance4.
Screening and Treating UTI Complications
Women who are not pregnant and show no risk factors can be tested for UTI through a simple urine dipstick. The presence of leukocyte and absence of nitrite can be considered a positive UTI diagnosis. However, where complications are likely, a urine culture is required. Cultures can be carried out on blood or MacConkey agar and require preservation of the sample in boric acid, or in a refrigerator, for 24 hours prior to testing. This culture can then be isolated and used to identify the strain of bacteria causing the infection7.
Species identification is imperative in maternal UTIs. Different species have different levels of sensitivity to the various antibiotics available. E. coli, for example, shows 93% sensitivity to Nitrofurantoin but is only 86% sensitive to Fosfomycin. Selection of the correct treatment can ameliorate symptoms rapidly and reduce the possible complications for both mother and baby4. Many species of bacteria known to be responsible for UTIs have displayed resistance to antibiotics. Group B streptococcus has been shown to be 42% resistant to clindamycin4. The selection of antibiotics available to clinicians treating maternal UTI are already limited as many antibiotics have been associated with increased risk of miscarriage and birth defects independent of UTI1.
With the patient in mind, Randox provides clinicians with both laboratory and near patient testing solutions. Bringing to the market, to help eliminate distress and improve testing turnaround times, the Randox Urinary Tract Infection Array. It has the ability to detect 30 bacterial, fungal, and associated antibiotic resistance markers from a single urine sample in under four hours. This multiplex diagnostic tool can help detect specific bacterial and fungal strains known to cause UTI allowing laboratories to confidently diagnose patients in a timely manner, aiding with targeted treatments and helping to reduce risk of complications.
The Ongoing UTI Battle
Maternal UTI is a very common problem resulting in many fatalities and morbidities worldwide. It is crucial to identify and characterize these infections to limit the negative effects seen to both mothers and their children. Quick and efficient screening is paramount in the battle against bacteria to allow the prescription of targeted treatment. While antibiotics are often an effective weapon against UTIs, care should be taken when prescribing these treatments to pregnant women due to the potential adverse effects that have been reported. Furthermore, unnecessary treatments using antibiotics should be avoided at all costs due to the increasingly serious issue of antimicrobial resistance.
References
1.Eslami V, Belin S, Sany T, Ghavami V, Peyman N. The relationship of health literacy with preventative behaviours of urinary tract infection in pregnant women. Journal of Health Literacy. 2022;6(4):22-31. doi:https://doi.org/10.22038/jhl.2021.59768.1183
2.Bien J, Sokolova O, Bozko P. Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage. International Journal of Nephrology. Published online 2012:1-15. doi:https://doi.org/10.1155/2012/681473
3.Werter DE, Kazemier BM, van Leeuwen E, et al. Diagnostic work-up of urinary tract infections in pregnancy: study protocol of a prospective cohort study. BMJ Open. 2022;12(9):e063813. doi:https://doi.org/10.1136/bmjopen-2022-063813
4.Balachandran L, Jacob L, Al Awadhi R, et al. Urinary Tract Infection in Pregnancy and Its Effects on Maternal and Perinatal Outcome: A Retrospective Study. Cureus. 2022;14(1). doi:https://doi.org/10.7759/cureus.21500
5.Bono MJ, Reygaert WC. Urinary Tract Infection. Nih.gov. Published 2018. https://www.ncbi.nlm.nih.gov/books/NBK470195/
6.World Health Organization. Preterm birth. Who.int. Published February 19, 2018. Accessed February 8, 2023. https://www.who.int/news-room/fact-sheets/detail/preterm-birth
7.Sinawe H, Casadesus D. Urine Culture. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK557569/
8.Schrader SM, Botella H, Vaubourgeix J. Reframing antimicrobial resistance as a continuous spectrum of manifestations. Current Opinion in Microbiology. 2023;72:102259. doi:https://doi.org/10.1016/j.mib.2022.102259
9.Murray CJ, Ikuta KS, Sharara F, et al. Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. The Lancet. 2022;399(10325):629-655. doi:https://doi.org/10.1016/S0140-6736(21)02724-0
10.Ali J, Rafiq QA, Ratcliffe E. Antimicrobial resistance mechanisms and potential synthetic treatments. Future Science OA. 2018;4(4):FSO290. doi:https://doi.org/10.4155/fsoa-2017-0109
11.Nelson DW, Moore JE, Rao JR. Antimicrobial resistance (AMR): significance to food quality and safety. Food Quality and Safety. 2019;3(1):15-22. doi:https://doi.org/10.1093/fqsafe/fyz003
12.Myers AL. Curbside Consultation in Pediatric Infectious Disease : 49 Clinical Questions. Slack; 2012:4.
13.Oie S, Kamiya A, Hironaga K, Koshiro A. Microbial contamination of enteral feeding solution and its prevention. American Journal of Infection Control. 1993;21(1):34-38. doi:https://doi.org/10.1016/0196-6553(93)90205-i
7. Sinawe H, Casadesus D. Urine Culture. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK557569/