![]() Urogenital tuberculosis and parasitic organisms such as Schistosoma haematobium can cause UTIs, although these infections are not common in the USA 9. Fungal UTIs are not as common as bacterial UTIs, but patients with indwelling catheters, diabetes, or recent antibiotic use are at increased risk of fungal infection 7, 8. The majority of UTIs are caused by Gram-negative pathogens, primarily from the Enterobacteriaceae family including Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Enterobacter species 1– 3, 6. Complicating factors, such as obstructing urinary stones, indwelling catheters, and urinary tract surgery increase the risk of urosepsis, which has an associated mortality as high as 20% 4, 5. ![]() UTIs are among the most prevalent community-acquired and hospital-acquired infections, affecting almost 50% of the population at least once in their lifetime, accounting for considerable morbidity and health-care expenditure with an estimated annual cost of US$3.5 billion in the USA 1– 3. Successful development and implementation of these technologies has the potential to usher in an era of precision medicine to improve patient care and public health. Emerging technologies including biosensors, microfluidics, and other integrated platforms could improve UTI diagnosis via direct pathogen detection from urine samples, rapid antimicrobial susceptibility testing, and point-of-care testing. Optimization for direct urine testing would reduce the time to diagnosis, yet these technologies do not provide comprehensive information on antimicrobial susceptibility. New diagnostic platforms, including nucleic acid tests and mass spectrometry, have been approved for clinical use and have improved the speed and accuracy of pathogen identification from primary cultures. In addition to improved antimicrobial stewardship and the development of new antimicrobials, novel diagnostics are needed for timely microbial identification and determination of antimicrobial susceptibilities. The common use of empirical antibiotics has contributed to the rise of multidrug-resistant organisms, reducing treatment options and increasing costs. Urine culture with antimicrobial susceptibility testing takes 2 3 days and requires a clinical laboratory. Urine dipsticks are fast and amenable to point-of-care testing, but do not have adequate diagnostic accuracy or provide microbiological diagnosis. Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs.
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