Point-of-care tests for urinary tract infections: A systematic review and meta-analysis of diagnostic accuracy and antimicrobial susceptibility assessment.

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, driving significant antibiotic use. The gold standard methods like urine culture, are very time consuming and may delay the right treatments at right time. Rapid diagnosis with point-of-care tests (POCTs) have emerged as potential alternatives, offering potential benefits in pathogen identification (ID) and antimicrobial susceptibility testing (AST). The main objective of this review is to evaluate the diagnostic accuracy of the POCTs in view of sensitivity, specificity, and dual assessment of pathogen ID with AST. The literature search was conducted across PubMed, MEDLINE, Europe PMC, and Google Scholar, limited to English-language publications, and covered studies up to April 30, 2025, the date of completion before manuscript submission. The review included diagnostic test accuracy studies, cross-sectional diagnostic validation studies, randomized and non-randomized controlled trials, and prospective comparative studies that enrolled both male and female patients across all age groups in primary care, outpatient, or tertiary healthcare settings with a suspicion of UTI. The comparator in all studies was standard urine culture and sensitivity. The data extraction was done by four investigators independently, rated risk of bias and assessed the quality using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) framework. The assessment of diagnostic test accuracy were analyzed with 95% CI. Fourteen studies were included in the review. Meta-analysis was performed on 12 studies for pathogen ID and 9 studies for AST, yielding pooled sensitivity and specificity estimates for both outcomes. Pooled sensitivity and specificity were 92.2% and 92.7% for pathogen ID, and 92.1% and 89.2% for AST. Time-to-result ranged <1 h to 24 hours. High diagnostic accuracy aids clinical efficacy, though heterogeneity and enactment barriers remain. POCTs have shown potential accuracy for UTI diagnosis and AST, facilitating rapid decisions, but further validation and cost studies remain necessary.