GOLD-STANDARD FOR DIAGNOSING UTIs IS 'INCOMPETENT'
One out of every five times the urine culture for diagnosing UTIs reports a false negative.
That’s the findings of a 2017 clinical study and much of what James Malone-Lee, an emeritus professor of medicine at University College London, has done his research on.
“It's difficult to be sufficiently rude about it [the urine culture test], to be honest,” said Malone-Lee, who has been exploring the topic of UTI diagnosis and treatment for the past 20 years.
When he first started investigating the topic, he noted fundamental experiments about the urine culture test had never been conducted, meaning for the past 60 years, the test was being used with unproven assumptions.
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Malone-Lee discovered the normal human bladder isn’t sterile, as previously believed; it contained living, non-harmful microbes. With the urine culture test, an underlying infection was thought to be present if the culture grew bacteria, but Malone-Lee’s research showed that the presence of bacteria doesn’t necessarily mean the presence of infection.
“With that discovery, the whole urine culture edifice collapses; it is a world-class dud,” he said.
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“The other thing we discovered was the mixed growth of doubtful significance was far from insignificant,” he said. Mixed growth of doubtful significance means more than one type of organism is found in the urine culture; these test results are assumed to be contaminated during collection. But Malone-Lee said these results are significant, and modern data suggests mixed organisms are more likely to cause infection.
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As a result, Malone-Lee said there has been a constant rise in the number of women and men presenting with interstitial cystitis (IC) — an incurable condition that causes bladder and pelvic pain. Malone-Lee said the IC diagnosis is often used to explain away patients that present with typical UTI symptoms, but for whom the urine culture results are negative.
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He said of the 7,000 patients he has seen with diagnosed IC, 99 per cent of them actually have a chronic urinary tract infection.
“It comes from the naive application of guidelines that promotes bad practice by encouraging people to ignore the base rate, and secondly deploying incompetent tests.”
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If not the urine culture test, then what is the best way to diagnose UTIs? Malone-Lee suggests the patient history and examination are sufficient.
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“You’ve got to treat the human being coming into you as a remarkably sensitive instrument that’s telling you what’s wrong,” he said.
Malone-Lee said despite the science showing the urine culture test to be unreliable, it will be a slow process for doctors to change their ways.
LONG-TERM ANTIBIOTIC TREATMENT OF UTIs
According to Malone-Lee, another significant problem is the short-term antibiotic treatment of UTIs. The infection oscillates, he explained, with the symptoms going up and down and infected cells being shed through the urine. However, over time the bacteria move into the cells of the bladder, where they become dormant for a period and are immune to antibiotics.
“They’re identical to weed seeds in your garden, they’re waiting to come out,” he said.
As the bladder wall goes through its natural shedding cycle, the dormant bacteria is released, and the infection starts again.
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Malone-Lee said if you have acute cystitis and you’re treated with a three to fourteen-day course of antibiotics, the failure rates run between 25 and 35 per cent.
Chronic urinary tract infections can be treated, and Malone-Lee’s method involves the long-term use of antibiotics. A controversial approach as some fear this will lead to antimicrobial resistance (AMR).
However, a review published in 2018 by the International Urogynecological Journal, that followed the treatment of 624 women for lower urinary tract symptoms over ten years showed the women got better, and there were no instances of AMR.
