July 11, 2025
McKnight's Long-Term Care News
An expert panel convened by the nation’s top post-acute care medical organization has recommended against the routine use of urine PCR tests to diagnose urinary tract infections.
Such tests have exploded in use in recent years, but their inability to equate high bacteria load with specific clinical implications makes them an inadequate tool for nursing home residents, the PALTmed team reported in a new consensus statement published last week in the Journal of the American Medical Directors Association.
Using PCR, a polymerase chain reaction test that provides fast results, may lead to overdiagnosis of UTIs and the misuse of antibiotics, the experts said.
“Inappropriate urine testing is often driven by concerns about missing an infection and misconceptions about the significance of nonspecific symptoms,” wrote the researchers, led by Jessica Zering, PharmD, with the Washington State Department of Health’s Communicable Disease Epidemiology division.
“When ordered in the absence of clinical signs and symptoms of a UTI, these results are frequently misinterpreted as indicative of infection, leading to unnecessary antibiotic prescribing,” they added. “This practice puts patients at risk of significant harms, including Clostridium difficile infections and antibiotic resistance.”
UTIs are the most common infection in nursing homes, and the authors noted that more than half of antibiotics prescribed in PALTC settings for UTIs are considered inappropriate.
The expert panel included representatives from the Nebraska Department of Health, the University of Rochester Medical Center, Penn State University, and the University of Nebraska Medical Center.
They examined the use and limits of urine molecular testing for organisms by PCR, which has been available since 2016 but whose use has exploded in recent years. It can detect up to 42 different organism types in a single sample, along with several antibiotic resistance genes but reports bacteria load as low, medium or high and without the detailed insights providers need to choose the right medications.
Instead, results — delivered much more quickly than traditional culture-based tests — are often accompanied by the lab’s antibiotic recommendations. Unlike traditional diagnostics, they aren’t regulated by the FDA and interpretation standards may vary between laboratories.
Lack of evidence for change
The 200-year-old urine culture is still considered the “gold standard diagnostic method,” the statement states, but a delay between ordering a culture and receiving the results up to 72 hours later poses a challenge to timely diagnosis and targeted treatment.
“This delay in availability of culture results can hinder the ability to escalate therapy in response to an antibiotic-resistant organism, putting patients at risk of more significant illness,” they wrote. “Although newer testing options are needed in the PALTC setting for UTIs … significant evidence gaps exist when comparing PCR to the current standard of care.”
Most research into PCR testing has been funded by the industry, the authors noted.
In addition, a nationwide analysis of Medicare claims data showed that the median cost of PCR in 2023 was $585 compared with $8 for a urine culture.
“PALTC settings should continue to use standard-of-care culture techniques when appropriate to diagnose and treat UTI,” they write in their formal recommendations. “Additionally, antibiotic stewardship programs should use the CDC’s Core Elements of Antibiotic Stewardship for Nursing Homes as a framework to engage with the multidisciplinary team when making decisions on urine testing.”
The consensus statement is endorsed by the Society for Healthcare Epidemiology of America, the Association for Professionals in Infection Control and Epidemiology, and the American Association of Post-Acute Care Nursing.
The authors also called for more research to develop new urinary diagnostic methods or biomarkers to help refine clinical outcomes associated with urine PCR testing and “optimize its application in older adults.”
“Establishing thresholds for clinical relevance and treatment for organisms detected on urine PCR testing is also needed,” they wrote. “Additionally, the impact of urine PCR on antibiotic prescribing practices should be examined to determine the benefits or barriers to stewardship programs.”
