1 Recommendations
1.1 The following point-of-care tests are not recommended for early routine use for suspected urinary tract infections (UTIs) in primary or community care settings in the NHS while further evidence is generated:
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Astrego PA‑100 analyser with the PA AST panel U‑0501 (Sysmex Astrego)
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Uriscreen (Savyon Diagnostics).
They show promise in guiding antimicrobial prescribing, and further research and completion of ongoing studies would allow the risks and benefits of early routine use in the NHS to be understood.
1.2 Further research is recommended on how:
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accurate the tests are in detecting and identifying bacteria and testing for antibiotic susceptibility (depending on the test's functions; see section 4.1)
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the tests affect antibiotic prescribing (see section 4.2).
1.3 The following culture-based point-of-care tests are not recommended for early routine use in NHS primary or community care settings for suspected UTIs:
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Diaslide, DipStreak and ChromoStreak (Novamed)
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Flexicult Human (SSI Diagnostica)
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Uricult, Uricult trio and Uricult plus (Aidian).
They are not expected to give results quickly enough to improve antimicrobial prescribing in these settings.
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 agree 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 early routine use 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, and Uriscreen), 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, so it is uncertain if the tests will improve care. 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 of people (for example the TOUCAN study).
Some of the tests considered in this assessment are still awaiting regulatory approval. Tests are only 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 give results quickly enough to 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.