Point of care tests (POCT) have the potential to improve the urinary tract infection (UTI) diagnostic pathway, as they can provide a diagnosis quickly in near-patient settings, and some also identify causative pathogens/antimicrobial sensitivity.
To assess the clinical impact, accuracy, and technical characteristics of POCT for diagnosing UTI.
Five electronic databases, two clinical trials registries, study reports and review reference lists, and websites.
Randomised controlled trials/non-randomised studies and diagnostic test accuracy studies published since 2000.
People with suspected UTI.
Rapid tests (results <40 mins): Astrego PA-100 system, Lodestar DX, Uriscreen, UTRiPLEX. Culture tests (results <24 hours): Flexicult Human, ID Flexicult, Diaslide, Dipstreak, Chromostreak, Uricult, Uricult Trio, Uricult Plus.
Any.
Risk of Bias-2, QUADAS-2, QUADAS-C.
Narrative summary and bivariate random effects meta-analyses to estimate summary sensitivity and specificity.
Two RCTs evaluated Flexicult Human (one against standard care; one against ID Flexicult). No difference was reported in antibiotic use concordant with culture results (OR 0.84 95% CI 0.58-1.20) or appropriate antibiotic prescribing (OR 1.44 95% CI 1.03-1.99). Initial antibiotic prescribing was lower with Flexicult than standard care (OR 0.56 95% CI 0.35-0.88). No difference for other measures of antibiotic use, symptom duration, patient enablement, or resource use. Fifteen studies reported accuracy data. Limited data were available, with most POCT evaluated in single studies or not evaluated at all. Uriscreen (4 studies), Uricult trio (3 studies), Flexicult Human (4 studies) and ID flexicult (2 studies) had modest sensitivity and specificity.POCT were easier to use and interpret than standard culture.
There is currently insufficient evidence to support the use of POCTs in UTI diagnosis. Due to rapid development of POCT, this review should be updated regularly.

Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.