Elena Boland
Consultant, TTP
Kate Rouse
Consultant, TTP
Giles Sanders
Head of In Vitro Diagnostics, TTP
Keiko Yata
TTP (from TTP’s Women’s Health Initiative)
The blind spots of current diagnostics for urinary tract infections leave much room to improve antimicrobial stewardship and women’s health. It’s time for innovation and change.
Urinary tract infections (UTIs) are extremely common, and most women will experience at least one in their life. If left untreated, they can progress to serious kidney infections and sepsis and, in rare cases, can even be fatal.
Accurate UTI diagnosis slows AMR
UTIs are frequently treated with antibiotics, but if the wrong one is used, symptoms persist and patients are overexposed to ineffective antibiotics. Swift and accurate diagnosis, followed by the correct antibiotic choice, provides a line of defence against the growing threat of antimicrobial resistance (AMR).
Unfortunately, available diagnostics for UTIs are often inadequate, notes Giles Sanders, Head of In Vitro Diagnostics at TTP, a technology and product development services company with a strong focus on women’s health and AMR. “This can lead to patients being incorrectly denied treatment, prescribed the wrong antibiotics or prescribed several different antibiotics — all of which encourages AMR,” he says.
Why current methods of diagnosis are unreliable
The current diagnostic pathway often involves a urine sample being tested with a dipstick first, then sent for microbiological culture and antibiotic susceptibility testing. These methods have poor sensitivity and miss some genuine UTIs. Additionally, the culture test does not reliably detect all organisms and can take days to report a result. This means that GPs prescribe a ‘go-to’ antibiotic rather than one that will always properly target the infection. This can mean that patients suffer for days on the wrong antibiotic.
Keiko Yata from the Women’s Health Initiative at TTP, believes that the current ‘one-size-fits-all’ approach is failing patients and endangering antimicrobial stewardship. UTIs can be complex, she warns — and patients may be the best judge of whether they have one or not.
If the right test can deliver the right
treatment rapidly, the economic costs
will pay for themselves many times over.
“Patients can present to their GP saying: ‘I think I have a UTI’,” says Yata. “So, they’re given a dipstick or culture test which — because they are unreliable — come back negative, and they are told that no treatment is necessary. Yet, the patient knows they have a UTI — and the GP probably does, too. It’s not a helpful situation. Also, blind antibiotic prescribing could be driving AMR.” Yata also believes that the burden of UTIs should be more recognised. “Because the subject of UTIs is still taboo, women don’t always feel they can talk openly about them. That has to change.”
Diagnostics that can address women’s health and AMR
While current diagnostics can be useful, they don’t catch all cases, and they take too long. Therefore, we should embrace more sophisticated and trustworthy techniques. For example, antimicrobial susceptibility testing (AST) at the point of care could be hugely valuable. One such test launched in 2023, which monitors bacterial growth in real time and can provide antibiotic susceptibility profiles for five commonly used antibiotics in 45 minutes, won the Longitude AMR Prize in 2024.
“Another alternative would be molecular techniques, such as PCR or DNA sequencing, which could be used in cases where standard diagnostics don’t bring a resolution,” says Kate Rouse, TTP Consultant. While not commonly used, these tools could boost women’s healthcare and help prevent AMR spread.
Investing in more sophisticated techniques
Across the board, a more thoughtful and research-led approach could widen the range of diagnostic options available. For the good of patients and antimicrobial stewardship, there is no time to waste. “Diagnostic development takes time,” says Elena Boland, TTP Consultant. “Investment in this area is needed now. Otherwise, we risk moving ever closer to the catastrophic stage of being unable to use available antibiotics because of AMR.”
Giles Sanders agrees. “If the right test can deliver the right treatment rapidly, the economic costs will pay for themselves many times over,” he says. “Unfortunately, like many women’s health issues, it is an underfunded and under-researched area. Governments need to better appreciate the burden of UTIs and be willing to invest in modern diagnostic approaches.”
