Title: Point of care tests for urinary tract infections (UTI) to reduce antimicrobial resistance [DAP69]
Funder: Department of Health and Social Care

Abstract: What is the problem?_x000D_ Urine infections can be difficult to diagnose. This means patients may not get the best treatment straight away, or may be given antibiotics that they do not need._x000D_ At the moment, a urine infection is diagnosed by the GP based on your symptoms and by sending a urine sample to the lab to check whether you have a urine infection, and if so whether you have been given the right antibiotics for your infection. Labs can take up to a week to get the result of your urine test back to the GP. Antibiotic treatment is usually started straight away after seeing your GP. As they don’t yet have the results of your lab tests, this means that some people will be given antibiotics when they do not have a urine infection and some will be given the wrong type of antibiotics for the bug that is causing their infection._x000D_ In some people, dipstick tests can be used to help make a quicker diagnosis. Dipstick tests are plastic strips that are dipped into urine and then change colour if you are likely to have a urine infection. But these tests are not very good at telling us whether you have a urine infection, and they cannot tell us anything about what treatment will work for you._x000D_ Some new rapid tests have recently been developed that can be done in the GP surgery or pharmacy and will tell you quickly (some in just a few minutes) whether you have a urine infection. Some of these tests are also able to tell your doctor which bug is causing your infection, and which antibiotic will work best._x000D_ _x000D_ What are we trying to find out?_x000D_ We want to know whether introducing new rapid tests to diagnose UTIs will mean that more people are correctly told whether or not they have a urine infection, whether patients can get a correct diagnosis more quickly, and whether they can be treated with the right antibiotic more quickly. We also want to know whether introducing this type of testing is a good use of NHS money._x000D_ _x000D_ What are we going to do?_x000D_ We are going review existing research and develop economic (cost) models to answer the following questions:_x000D_ 1. Do people who have symptoms that suggest they might have a urine infection have better outcomes (right diagnosis, quicker diagnosis, quicker access to the right antibiotic, and better improvement in their symptoms) if they are diagnosed with a new rapid tests compared to current practice?_x000D_ 2. Can rapid tests reduce the amount of antibiotics that are prescribed?_x000D_ 3. Which test should people have to diagnose their urine infection and is it still necessary to send a urine sample to the lab to be tested?_x000D_ 4. Are new “point of care” tests a cost-effective use of NHS money?

Lay abstract: The overall aim of this project is to determine whether POCT for people with suspected UTI have the potential to be clinically and -cost effective to the NHS. We will summarise the available evidence to support the value proposition outlined in the scope and outline where there are evidence gaps._x000D_ 1. What is the impact on clinical outcomes of using POCT to diagnose UTI, with or without additional pathogen identification and AST?_x000D_ 2. What is the accuracy of the POCT for UTI diagnosis, pathogen identification and AST?_x000D_ 3. What is the technical performance (other than accuracy) of POCT for UTI?_x000D_ 4. What are the costs, from a UK NHS and Personal Social Services perspective, of using POCT for UTI diagnosis, pathogen identification and AST?_x000D_ 5. How might a conceptual model be specified in terms of structure and evidence required for parameterisation in order to estimate the cost effectiveness of POCT for UTI diagnosis, pathogen identification and AST?

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: INFECTION