New and emerging technologies for the diagnosis of urinary tract infections

Urinary tract infections affect 150 million people worldwide, yet the diagnosis of this common infection is not straightforward. Misdiagnoses and incorrect prescriptions are frequent in the treatment of urinary tract infections; this also contributes to the increase in antibiotic resistance among pathogens. Present diagnostic practices take 2-3 days for pathogen identification and antibiotic susceptibility testing. New technologies are urgently needed for improved patient care as well as to promote antibiotic stewardship. An ideal new diagnostic technology will test clinical urine samples directly and identify the pathogen and determine its antibiotic susceptibilities within a few hours such that the patient can be prescribed the appropriate antibiotic treatment the same day. Screening tools, such as flow cytometers and new dipstick assays, can help with rapidly identifying negative samples and improving workflow and reducing costs. Several groups have made progress in optimizing mass spectrometry methods for direct urine processing, and there are also new multiplex PCR panels that are specific for UTI pathogens and antibiotic resistance. We also discuss several emerging technologies - microfluidics, biosensors, real-time microscopy systems, and sequence-based diagnostics - that show huge potential in delivering rapid results.