An evaluation of Medicare claims information discovered a 60-fold improve in using unregulated speedy molecular diagnostic exams for urinary tract infections (UTIs) in older adults from 2016 to 2023, researchers reported yesterday in JAMA Community Open.
For the researchresearchers with the Facilities for Illness Management and Prevention (CDC) used Facilities for Medicare and Medicaid (CMS) claims information to evaluate the quantity and charge of paid claims for multiplex molecular syndromic panels for UTI amongst older Medicare beneficiaries.
Though urine tradition is the normal check for UTI, multiplex panels produce sooner outcomes, are extra analytically delicate, and might concurrently detect a number of pathogens and a few antibiotic-resistance genes.
Whereas the Meals and Drug Administration has accredited multiplex molecular syndromic panels for bloodstream, respiratory, and different sorts of infections, it has not accredited any such check for UTI prognosis. Nonetheless, the panels exist as laboratory-developed exams, and so they can be utilized in labs licensed below the Medical Laboratory Enchancment Amendments of 1988.
The researchers needed to get a greater understanding of how typically these unregulated exams are getting used, notably in older adults, for whom UTIs are a typical and main purpose for outpatient antibiotic use.
“Multiplex panels for UTIs are of explicit curiosity for monitoring, given the big variety of UTIs and the frequency with which antibiotics are given for asymptomatic bacteriuria, which can lead to affected person hurt,” the research authors wrote.
Potential to extend inappropriate antibiotic prescribing
The research included greater than 36 million older community-dwelling adults and nursing house residents with Medicare Half A and Half B advantages. Over the research interval, researchers recognized 1,679,328 claims for UTI multiplex testing. The median age of beneficiaries with claims was 77, and 66% of claims have been from feminine beneficiaries.
From 2016 to 2023, the noticed charge of UTI multiplex testing elevated from 2.4 to 148.1 claims per 10,000 fee-for-service beneficiaries yearly. The speed of urine cultures (1,116.2 claims/10,000 fee-for-service beneficiaries yearly) didn’t improve over the identical interval.
The rise in UTI multiplex testing was most pronounced amongst beneficiaries residing in nursing properties, rising from 1% in 2016 to 12% in 2020. Along with laboratories or pathologists, urology was the commonest clinician specialty conducting this testing.
Multiplex panels for UTIs are of explicit curiosity for monitoring, given the big variety of UTIs and the frequency with which antibiotics are given for asymptomatic bacteriuria, which can lead to affected person hurt.
The research additionally discovered that the price of UTI multiplex testing was 70 instances increased than urine cultures, with a median price per declare of $585 in 2023, in contrast with $8 for a urine tradition.
The research authors say that whereas revolutionary diagnostics are wanted to enhance turnaround instances and higher differentiate asymptomatic bacteriuria from UTIs, the shortage of specificity in UTI multiplex exams might result in extra antibiotic overprescribing. Moreover, there’s restricted proof demonstrating the good thing about UTI multiplex testing over urine tradition.
“Clinicians ought to concentrate on the shortage of information supporting this testing and the potential to additional contribute to inappropriate antibiotic prescribing,” they wrote. “Extra monitoring and analysis are wanted to find out the results of multiplex testing to diagnose UTI on antimicrobial use and whether or not there are scientific conditions wherein this testing might profit sufferers.”
In an accompanying editorialinfectious illness specialists from the College of Colorado College of Medication and the College of Maryland College of Medication say the findings increase considerations that the widespread and unregulated use of those exams will make a nasty state of affairs worse, notably in settings comparable to nursing properties, the place there’s restricted antimicrobial stewardship assist.
“Inappropriate therapy of misdiagnosed UTI in sufferers with asymptomatic bacteriuria (ASB) is already a considerable downside, notably amongst nursing house residents,” Margaret Fitzpatrick, MD, MS, and Daniel Morgan, MD, MS, wrote. “There may be excessive potential for urine molecular exams to extend antibiotic overuse, inflicting elevated antimicrobial resistance, antagonistic results, and well being care prices.”
They add that till information show the scientific utility of multiplex UTI exams in varied affected person populations and care settings, CMS and different payers ought to contemplate not reimbursing for these exams, and medical societies ought to spotlight the shortage of proof in UTI scientific pointers.
