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    The content on this page is not current guidance and is only for the purposes of the consultation process.

    Point of care tests for urinary tract infections to improve antimicrobial prescribing: early value assessment

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    1 Recommendations

    1.1 The following point of care tests cannot be used for early routine use for suspected urinary tract infections (UTIs) in primary or community care settings in the NHS while further evidence is generated. They show promise, and further research would allow the risks and benefits of early routine use in the NHS to be understood.

    • Astrego PA-100 analyser with the PA AST panel U-0501 (Sysmex Astrego)

    • Lodestar DX (Llusern Scientific; this technology is awaiting regulatory approval)

    • Uriscreen (Savyon Diagnostics)

    • UTRiPLEX (Global Access Diagnostics; this technology is awaiting regulatory approval).

    1.2 Further research is recommended on how:

    • accurate the test is in detecting and identifying bacteria and testing for antibiotic susceptibility (depending on the test's functions; see section 4.1)

    • the test affects antibiotic prescribing (see section 4.2).

    1.3 The following culture-based tests are not recommended for early routine use in primary or community care settings for suspected UTIs. They are not expected to give results quickly enough to affect antimicrobial prescribing in these settings.

    • Diaslide, DipStreak and ChromoStreak (Novamed)

    • Flexicult Human (SSI Diagnostica)

    • Uricult, Uricult trio and Uricult plus (Aidian).

          Why the committee made these recommendations

          Newer point of care tests for UTIs that give faster and more accurate results compared with current testing could improve outcomes and reduce the risk of antimicrobial resistance. Clinical experts said that these tests show promise, particularly if they can show which antibiotics the infection will respond to (antibiotic susceptibility testing).

          The tests are in the early stages of development and research is still being done. Uncertainties in the current evidence mean it is difficult to assess the risks and benefits of using these tests in the NHS while further evidence is generated.

          The tests vary in how quickly they give results. There is not much evidence for the more rapid point of care tests (Astrego, Lodestar DX, Uriscreen and UTRiPLEX), including if these tests give results quickly enough to improve antibiotic prescribing. Delays to appropriate antibiotic prescribing because a GP is waiting for test results or because a test has given inaccurate results could harm patients. Costs were only available for some of the tests so the cost to the NHS is also uncertain.

          So, rapid point of care tests cannot be recommended for early routine use in the NHS while further evidence is generated. Further research, for example on test accuracy, is recommended for these tests to see if this recommendation can be changed in the future. Ongoing studies may soon provide this for at least some groups within the scope (for example the TOUCAN study).

          Some of the tests are still awaiting regulatory approval. These were only included in the draft recommendation for further research if the company indicated this was expected in the next 12 months. Tests will only be included in the final guidance if they have appropriate regulatory approval by the date of final guidance publication.

          Evidence suggests that culture-based point of care tests that take around 16 to 24 hours to give results do not improve antibiotic prescribing in primary or community care. Clinical experts agree that these tests may be less useful in these settings. So they are not recommended for use in primary or community care settings.