Unlocking the potential of UTI POCT: what additional value can be added by rapid molecular tests?

Lead supervisor: Professor Gail Hayward

Co-supervisor: Dr Philip Turner

Commercial partner: Llusern Scientific Ltd

Suboptimal prescribing for urinary tract infection is a major driver of antimicrobial resistance, as many prescriptions may be unnecessary. Increasing clinical diagnostic certainty through use of diagnostics will improve antibiotic stewardship.

Point of Care UTI diagnostics, such as the Lodestar Dx, developed by Llusern Scientific, can provide binary diagnostic information to clinicians in a timeframe which can affect prescribing decisions. However, they also have the potential to offer additional microbiological and host response information which has not historically been available. This D.Phil aims to develop the evidence base for the clinical implications of this additional information.

This project will focus on 3 areas

1)           Added value of host biomarkers of infection, alongside the identification and speciation of bacteria in urine.

Candidate biomarkers identified by our recent systematic review will be tested using fresh anonymised urine samples from Public Health Wales (PHW), to demonstrate proof-of-concept for the use of biomarkers in diagnosing UTI from different patient groups and clinical indications.

2)           Clinical significance of polymicrobial infection.

A systematic review of the current evidence base for polymicrobial UTI will be performed. The student will then design and deliver studies comparing symptom duration/clinical outcomes of patients with laboratory-classified ‘mixed growth’ infections vs single species infection vs culture negative. The potential value of Lodestar Dx for diagnosing polymicrobial infection will be determined by using existing data generated through our collaboration to understand whether, if actioned, Lodestar may have altered treatment decisions.

3)           Are there uncharacterised ‘tricky to grow’ pathogens causing symptoms in culture-negative UTI patients, and can they be detected using molecular tests?

Culture negative samples from symptomatic patients will undergo microbiome analysis. Samples will also be tested using a panel of ‘rare pathogen’ targets.

Apply using course: DPhil in Primary Health Care