Dr. Varda on challenges in the diagnosis of urinary tract infection

In this interview, Briony K. Varda, MD, MPH, discusses the key take-home messages from the study, “Antibiotic Overtreatment of Presumed Urinary Tract Infection Among Children with Spina Bifida,” for which she served as the lead author. Varda is a pediatric urologist, the co-director of the spina bifida program, and the director of clinical research at Children’s National Hospital in Washington, DC.

Video Transcript:

What are the key take-home messages from this study?

The thing that was glaring to me is that patient symptoms should be the first and most important thing that we use to determine whether or not we treat our patients with spina bifida for a urinary tract infection. The testing just is not good enough yet to distinguish what's a true infection vs what represents chronic abacterial cystitis or bacterial colonization. So, my big take-home was to lean into symptoms. I think in terms of symptom elicitation, it's important to be systematic so that we don't shortchange certain populations when we try to figure out what their symptoms are.

Is there anything else that you’d like to add?

I think we're in dire need of a better diagnostic tool for urinary tract infections. We did a separate study using the same data and found that no matter what threshold of white blood cells you use for the urine, it was no better at predicting true UTI. So, I hope and know that many people are working in the lab to try to develop better tests. I would really just continue to encourage that. And then I would work with your institutional, emergency room, hospitalist, etc, antibiotic stewardship, to really ensure that this patient population isn't getting over treated and developing antibiotic resistance.

This transcription has been edited for clarity.