Date Published: June 7, 2018
Publisher: Public Library of Science
Author(s): Nichola-Jane M. Weir, Sally H. Pattison, Paddy Kearney, Bob Stafford, Gerard J. Gormley, Martin A. Crockard, Deirdre F. Gilpin, Michael M. Tunney, Carmel M. Hughes, Sylvia Bruisten.
Urinary Tract Infections (UTIs) are common bacterial infections, second only to respiratory tract infections and particularly prevalent within primary care. Conventional detection of UTIs is culture, however, return of results can take between 24 and 72 hours. The introduction of a point of care (POC) test would allow for more timely identification of UTIs, facilitating improved, targeted treatment. This study aimed to obtain consensus on the criteria required for a POC UTI test, to meet patient need within primary care.
Criteria for consideration were compiled by the research team. These criteria were validated through a two-round Delphi process, utilising an expert panel of healthcare professionals from across Europe and United States of America. Using web-based questionnaires, panellists recorded their level of agreement with each criterion based on a 5-point Likert Scale, with space for comments. Using median response, interquartile range and comments provided, criteria were accepted/rejected/revised depending on pre-agreed cut-off scores.
The first round questionnaire presented thirty-three criteria to the panel, of which 22 were accepted. Consensus was not achieved for the remaining 11 criteria. Following response review, one criterion was removed, while after revision, the remaining 10 criteria entered the second round. Of these, four were subsequently accepted, resulting in 26 criteria considered appropriate for a POC test to detect urinary infections.
This study generated an approved set of criteria for a POC test to detect urinary infections. Criteria acceptance and comments provided by the healthcare professionals also supports the development of a multiplex point of care UTI test.
Collectively, Urinary Tract Infections (UTIs) represent the second most common bacterial infections that occur within primary care, preceded only by respiratory infections. Management and treatment of UTIs is an enormous burden to healthcare systems accounting for 1–3% of all general practitioner (GP) consultations within primary care and approximately 30–50% of all antimicrobial prescriptions. The predominant urinary pathogen is Escherichia coli, responsible for 60–80% of all UTIs.[3,4] Culture remains the gold standard for the identification of bacterial species. However, it is slow, requiring 24–72 hours to report both the microorganism and provide an antibiotic resistance profile. In primary healthcare, prescriptions are often prescribed based on presentation alone, without use of a diagnostic test, or are based on dipstick tests, which lack accuracy and give no indication as to the infecting agent.
A summary of the Delphi process is shown in Fig 1. Twenty eight criteria were developed using a range of sources (see above) and reviewed. Consultation within the steering group derived an additional five, thus thirty-three criteria were presented in the first round of the Delphi process. All 17 panel members who agreed to participate in this Delphi exercise completed the first round of the questionnaire. Group consensus (by overall agreement) was achieved for 22 criteria, which were accepted as criteria required for a POC test for UTIs. Consensus was not achieved for 11 criteria; these were reviewed and discussed by the Steering Group. This resulted in the removal of one criterion as it had been adequately covered by other criteria. Raw data from the Delphi questionnaire (Round 1) have been provided in S1 Table, and comments from the Round 1 survey have been provided in S3 File.
Using a Delphi consensus method, we developed a list of criteria for an acceptable POC test for detection of urinary pathogens. The expert panel facilitated development of the criteria through their level of agreement, and revisions to statements were based on comments provided by panellists.
Within our study, key themes have been discussed and agreed by the Delphi panel, indicating the important features of a POC test. Criteria relating to intended use, detection and identification of urinary pathogens, features and performance and ease of use, all achieved consensus. If such tests are to be used in everyday practice, more targeted treatment of antibiotics could be provided to patients for the treatment of UTIs. This study supports previous research in that the need for a POC UTI test has been highlighted . We have also refined the criteria, with consensus on the type and characteristics of the test, across a broad spectrum of healthcare professionals.