From the Guidelines
Next-generation DNA sequencing should not be used as a routine diagnostic tool to assess for urinary tract infections (UTIs) due to its limited ability to distinguish between true infection and asymptomatic bacteriuria (ASB) 1. The current evidence suggests that the role of molecular techniques, including next-gen DNA sequencing, in the diagnosis of UTIs is limited, and urine culture remains the reference standard for confirming the etiologic pathogen in patients with suspected infection 1. Some key points to consider when evaluating the use of next-gen DNA sequencing for UTI diagnosis include:
- The inability of molecular diagnostics to distinguish true infection from ASB 1
- The lack of standardization in determining bacterial viability or quantitation in urine specimens using molecular techniques 1
- The potential for overtreatment due to the increased sensitivity of molecular tests, which may detect clinically insignificant bacteria 1
- The need for clear guidelines to avoid unnecessary therapy 1 While next-gen DNA sequencing may have value in specific scenarios, such as recurrent or complicated UTIs, its use as a routine diagnostic tool is not currently recommended due to the limitations mentioned above. Instead, standard urine culture, urinalysis, and clinical assessment should continue to be the primary methods for diagnosing and managing UTIs.
From the Research
Use of Next-Gen DNA Sequencing for UTI Assessment
- Next-gen DNA sequencing, particularly metagenomic next-generation sequencing (mNGS), has shown promise in enhancing the diagnosis of urinary tract infections (UTIs) 2, 3.
- The technology allows for unbiased pathogen detection, which can be particularly useful in cases where traditional urine culture methods may fail to identify the causative organism 2, 4.
- Studies have demonstrated that mNGS can detect a broader spectrum of pathogens compared to conventional culture methods, including anaerobic bacteria and mixed infections 2, 3.
- The use of mNGS has been shown to improve the detection of pathogens, guide changes in treatment strategies, and provide a more accurate diagnosis of UTIs 2, 3.
- The sensitivity and specificity of mNGS in diagnosing UTIs have been reported to be high, with values ranging from 81.4% to 100% and 92.3% to 100%, respectively 3.
- Next-gen DNA sequencing can also provide information on antimicrobial resistance factors, which can aid in the selection of effective antibiotic therapy 5.
- However, the implementation of these novel diagnostic methods may require adaptation to new concepts and challenges to avoid misdiagnosis and overtreatment 4.