Plenary: Next Frontier, Sunday
Plenary: Next Frontier
Presentation Authors: Michael McDonald*, Darien Kameh, Celebration, FL, Mark E. Johnson, Orlando, FL, Vladimir Mouraviev, Davenport, FL
Introduction: The aim of our study was to conduct a Head to Head Comparative Phase II trial of standard urine culture and sensitivity versus DNA next generation sequencing testing for diagnosis and treatment efficacy in patients with urinary tract infections (UTI) based on short-term outcomes.
Methods: Between January 2016 and December 2016, 56 patients were entered into this study with symptoms of an UTI, 44 patients completed the study. All subjects completed a standardized UTI symptom score questionnaire on day 0-7 and day 14. Twenty-two volunteers were entered as controls in this study without symptoms of a urinary tract infection. The Level 1 Panel as a quantitative real-time Polymerase chain reaction (PCR) test for bacteria and fungi and the Level 2 test which detects virtually all microbial organisms and fungal pathogens were used versus routine culture and sensitivity test.
Results: The symptom scores were statistically significantly better for those patients whose diagnosis and treatment was based on DNA results versus traditional culture studies. For instance, all 44 patients showed positive results in DNA sequencing tests, while only 13/44 patients had positive urine culture tests. The difference in average improvement of 8.5 is highly significant (p<0.0001) (Fig.1). Especially in the cohort of patients with DNA positive test and culture negative the treatment outcomes were improved with respect to symptom scores when they started treatment on day 8. That ultimately led to faster recovery times and decreased the cost of treatment. Advantages of the DNA test also include an increased sensitivity for the diagnosis of anaerobic flora.
Conclusions: In this study DNA testing demonstrated a more accurate diagnosis of UTI than standard urine culture tests. In addition, DNA next generation testing led to better treatment outcomes in patients treated with antibiotics for primary anaerobic, aerobic or a combination of bacteria. Therefore, DNA testing allowed for the improved diagnosis and treatment based on symptoms of a UTI especially when urine cultures are negative.
Figure 1. Box-plot of Symptom Severity Reduction at Day 14 in Treatment Arms (group 1- based on culture and sensitivity, group 3 and 4- based on DNA results)
Source Of Funding: None
University of Central Florida
Michael McDonald, MD, Associate Professor of Surgery, University of Central Florida, Orlando, Florida.
Dr. Michael McDonald was born and raised in Ottawa, Canada. He received his undergraduate degree from St. Francis Xavier University in Nova Scotia, Canada. He obtained his medical degree and completed his urology residency from the University of Ottawa in 1989 and 1994 respectively. In 1996 he completed a fellowship at the University California, San Francisco in Endourology under the tutelage of Dr. Marshall Stoller. He went into private practice in Kentucky until 2006 when he then joined the staff at Florida Hospital, Celebration in Celebration, Florida. Dr. McDonald has been published in the Journal of Urology, the Journal of Endourology among other journals. He is presently on staff as Associate Professor of Surgery at the University of Central Florida and is actively pursuing both academic and non-academic endeavors.