The evidence landscape for direct-from-urine antibiotic susceptibility testing (AST) for urinary tract infection...

Antimicrobial susceptibility tests (AST) are vital to guide antibiotic selection to treat bacterial infections, including urinary tract infections (UTI). Current laboratory AST takes at least 2 days. Direct testing of urine samples could speed up testing, with rapid reporting aiding timely treatment.

A scoping review was conducted to identify studies assessing the accuracy of direct-from-urine AST, and map the breadth of evidence. Studies that measured overall categorical agreement (CA) compared to a reference method were selected, and the reported accuracy, the type of AST method and study methodology assessed.

In total, 33 studies were identified that met the inclusion criteria (1976-2024). These reported overall CA for direct-from-urine AST ranging from 78.7% to 100% compared to a reference method. These studies varied in the AST method used; in urine sample collection, origin and processing; in the antibiotics evaluated; in study design and data analysis. The most common AST method evaluated was direct-from-urine disc diffusion. Most studies reported accuracy only for samples containing a single Gram-negative organism.

Although increasing numbers of studies report the accuracy of direct-from-urine AST, heterogeneity prevented systematic comparison of methods or detailed meta-analysis. Many studies reported overall accuracy >90% CA for urine samples containing a single Gram-negative organism across several direct-from-urine AST methods, offering potential time saving compared with current methods. However, as single organism samples represent only a subset of urines taken from UTI patients, additional studies-that include analysis of samples containing mixed cultures and Gram-positive isolates-are still required.