{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:23:09Z","timestamp":1791984189810,"version":"4.4.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Multiplex molecular syndromic panels for diagnosis of urinary tract infection (UTI) lack clinical data supporting their use in routine clinical care. They also have the potential to exacerbate inappropriate antibiotic prescribing.<\/jats:p><\/jats:sec>Objective<\/jats:title>To describe the frequency of unspecified multiplex testing in administrative claims with a primary diagnosis of UTI in the Medicare population over time, to assess costs, and to characterize the health care professionals (eg, clinicians, laboratories, physician assistants, and nurse practitioners) and patient populations using these tests.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used Centers for Medicare &amp;amp; Medicaid Services (CMS) claims data for Medicare beneficiaries. The study included older community-dwelling adults and nursing home residents with fee-for-service Medicare Part A and Part B benefits from January 1, 2016, to December 31, 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Multiplex syndromic panels were identified using carrier claims (ie, claims for clinician office or laboratory services). The annual rate of claims was measured for multiplex syndromic panels with a primary diagnosis of UTI per 10\u202f000 eligible Medicare beneficiaries. The performing and referring specialties of health care professionals listed on claims of interest and the proportion of claims that occurred among beneficiaries residing in a nursing home were described.<\/jats:p><\/jats:sec>Results<\/jats:title>Between 31\u202f110\u202f656 and 36\u202f175\u202f559 Medicare beneficiaries with fee-for-service coverage annually (2016-2023) were included in this study. In this period, 1 679 328 claims for UTI multiplex testing were identified. The median age of beneficiaries was 77 (IQR, 70-84) years; 34% of claims were from male beneficiaries and 66% were from female beneficiaries. From 2016 to 2023, the observed rate of UTI multiplex testing increased from 2.4 to 148.1 claims per 10\u202f000 fee-for-service beneficiaries annually, and the proportion of claims that occurred among beneficiaries residing in a nursing home ranged from 1% in 2016 to 12% in 2020. In addition to laboratories or pathologists, urology was the most common clinician specialty conducting this testing. The CMS-assigned referring clinician specialty was most frequently urology or advanced practice clinician for claims among community-dwelling beneficiaries compared with internal medicine or family medicine for claims among nursing home residents. In 2023, the median cost of a multiplex test in the US was $585 (IQR, $516-$695 for Q1-Q3), which was more than 70 times higher than the median cost of $8 for a urine culture (IQR, $8-$16 for Q1-Q3).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cohort study of Medicare beneficiaries with fee-for-service coverage from 2016 to 2023 found increasing use of emerging multiplex testing for UTI coupled with high costs to the Medicare program. Monitoring and research are needed to determine the effects of multiplex testing on antimicrobial use and whether there are clinical situations in which this testing may benefit patients.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.46842","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T16:04:25Z","timestamp":1732637065000},"page":"e2446842","source":"Crossref","is-referenced-by-count":7,"title":["Use of Multiplex Molecular Panels to Diagnose Urinary Tract Infection in Older Adults"],"prefix":"10.1001","volume":"7","author":[{"given":"Kelly M.","family":"Hatfield","sequence":"first","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Kabbani","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"See","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin W.","family":"Currie","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Jacobs Slifka","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley S.","family":"Magill","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauri A.","family":"Hicks","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Clifford","family":"McDonald","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Jernigan","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujan C.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph D.","family":"Lutgring","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"issue":"1","key":"zoi241332r1","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2024.10","article-title":"A decade of clinical microbiology: top 10 advances in 10 years: what every infection preventionist and antimicrobial steward should know.","volume":"4","author":"Jhaveri","year":"2024","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"issue":"9","key":"zoi241332r2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00495-19","article-title":"Clinical utility of advanced microbiology testing tools.","volume":"57","author":"Miller","year":"2019","journal-title":"J Clin Microbiol"},{"issue":"1","key":"zoi241332r3","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00024-17","article-title":"Syndromic panel-based testing in clinical microbiology.","volume":"31","author":"Ramanan","year":"2017","journal-title":"Clin Microbiol Rev"},{"issue":"11","key":"zoi241332r5","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.1093\/cid\/ciy357","article-title":"Clinical impact of a multiplex gastrointestinal polymerase chain reaction panel in patients with acute gastroenteritis.","volume":"67","author":"Cybulski","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"9","key":"zoi241332r6","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00311-20","article-title":"Utilization, yield, and accuracy of the filmarray meningitis\/encephalitis panel with diagnostic stewardship and testing algorithm.","volume":"58","author":"Broadhurst","year":"2020","journal-title":"J Clin Microbiol"},{"issue":"1","key":"zoi241332r7","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1128\/JCM.01766-16","article-title":"Combined testing for chlamydia, gonorrhea, and trichomonas by use of the BD Max CT\/GC\/TV assay with genitourinary specimen types.","volume":"55","author":"Van Der Pol","year":"2016","journal-title":"J Clin Microbiol"},{"issue":"3","key":"zoi241332r8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.0830","article-title":"Diagnostic stewardship in community-acquired pneumonia with syndromic molecular testing: a randomized clinical trial.","volume":"7","author":"Markussen","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"7","key":"zoi241332r9","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1093\/cid\/civ447","article-title":"Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing.","volume":"61","author":"Banerjee","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"4","key":"zoi241332r10","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1093\/cid\/ciab672","article-title":"Advancing diagnostic stewardship for healthcare-associated infections, antibiotic resistance, and sepsis.","volume":"74","author":"Curren","year":"2022","journal-title":"Clin Infect Dis"},{"key":"zoi241332r11","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.euros.2022.08.009","article-title":"Molecular diagnostic methods versus conventional urine culture for diagnosis and treatment of urinary tract infection: a systematic review and meta-analysis.","volume":"44","author":"Szlachta-McGinn","year":"2022","journal-title":"Eur Urol Open Sci"},{"key":"zoi241332r12","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.urology.2019.10.018","article-title":"Multiplex PCR based urinary tract infection (UTI) analysis compared to traditional urine culture in identifying significant pathogens in symptomatic patients.","volume":"136","author":"Wojno","year":"2020","journal-title":"Urology"},{"issue":"2","key":"zoi241332r13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0017146","article-title":"Rapid qualitative urinary tract infection pathogen identification by SeptiFast real-time PCR.","volume":"6","author":"Lehmann","year":"2011","journal-title":"PLoS One"},{"issue":"3","key":"zoi241332r14","doi-asserted-by":"publisher","first-page":"479","DOI":"10.3390\/diagnostics11030479","article-title":"A new gold rush: a review of current and developing diagnostic tools for urinary tract infections.","volume":"11","author":"Xu","year":"2021","journal-title":"Diagnostics (Basel)"},{"issue":"1","key":"zoi241332r15","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2024.71","article-title":"Urine polymerase chain reaction tests: stewardship helper or hinderance?","volume":"4","author":"Zering","year":"2024","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"issue":"12","key":"zoi241332r17","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1038\/nrurol.2010.190","article-title":"The epidemiology of urinary tract infection.","volume":"7","author":"Foxman","year":"2010","journal-title":"Nat Rev Urol"},{"issue":"17","key":"zoi241332r18","doi-asserted-by":"publisher","first-page":"1864","DOI":"10.1001\/jama.2016.4151","article-title":"Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011.","volume":"315","author":"Fleming-Dutra","year":"2016","journal-title":"JAMA"},{"issue":"1","key":"zoi241332r21","doi-asserted-by":"publisher","first-page":"80","DOI":"10.7861\/clinmedicine.11-1-80","article-title":"Diagnosis and management of urinary infections in older people.","volume":"11","author":"Woodford","year":"2011","journal-title":"Clin Med (Lond)"},{"issue":"10","key":"zoi241332r22","doi-asserted-by":"publisher","first-page":"e83","DOI":"10.1093\/cid\/ciz021","article-title":"Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America.","volume":"68","author":"Nicolle","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"7","key":"zoi241332r23","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1093\/cid\/ciab749","article-title":"Envisioning future urinary tract infection diagnostics.","volume":"74","author":"Patel","year":"2022","journal-title":"Clin Infect Dis"},{"issue":"4","key":"zoi241332r24","first-page":"213","article-title":"A head-to-head comparative phase II study of standard urine culture and sensitivity versus DNA next-generation sequencing testing for urinary tract infections.","volume":"19","author":"McDonald","year":"2017","journal-title":"Rev Urol"},{"issue":"10","key":"zoi241332r25","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1111\/j.1532-5415.1991.tb04042.x","article-title":"Incidence and characteristics of antibiotic use in aged nursing home patients.","volume":"39","author":"Warren","year":"1991","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"zoi241332r26","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.jamda.2013.11.009","article-title":"Clinical uncertainties in the approach to long term care residents with possible urinary tract infection.","volume":"15","author":"Nace","year":"2014","journal-title":"J Am Med Dir Assoc"},{"key":"zoi241332r27","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/1471-2318-12-73","article-title":"Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes.","volume":"12","author":"Phillips","year":"2012","journal-title":"BMC Geriatr"},{"key":"zoi241332r29","first-page":"165","article-title":"Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives.","volume":"9","author":"Lim","year":"2014","journal-title":"Clin Interv Aging"},{"issue":"8","key":"zoi241332r30","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1086\/501798","article-title":"Antimicrobial use in long-term-care facilities.","volume":"21","author":"Nicolle","year":"2000","journal-title":"Infect Control Hosp Epidemiol"},{"key":"zoi241332r4","unstructured":"List of microbial tests. US Food and Drug Administration. 2024. Accessed April 15, 2024. https:\/\/www.fda.gov\/medical-devices\/in-vitro-diagnostics\/nucleic-acid-based-tests#microbial"},{"key":"zoi241332r16","unstructured":"Laboratory developed tests. US Food and Drug Administration. 2024. Accessed May 7, 2024. https:\/\/www.fda.gov\/medical-devices\/in-vitro-diagnostics\/laboratory-developed-tests"},{"key":"zoi241332r19","unstructured":"Data documentation: carrier (fee-for-service). Research Data Assistance Center. 2021. Accessed May 7, 2024. https:\/\/resdac.org\/cms-data\/files\/carrier-ffs\/data-documentation"},{"key":"zoi241332r20","unstructured":"Medicare provider and supplier taxonomy crosswalk. Centers for Medicare & Medicaid Services. Accessed June 10, 2024. https:\/\/data.cms.gov\/provider-characteristics\/medicare-provider-supplier-enrollment\/medicare-provider-and-supplier-taxonomy-crosswalk"},{"key":"zoi241332r28","unstructured":"Core elements of antibiotic stewardship for nursing homes. Centers for Disease Control and Prevention. 2024. Accessed May 6, 2024. https:\/\/www.cdc.gov\/antibiotic-use\/hcp\/core-elements\/nursing-homes-antibiotic-stewardship.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2827067\/hatfield_2024_oi_241332_1732034379.35682.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T16:04:31Z","timestamp":1732637071000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2827067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,26]]},"references-count":30,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11,4]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.46842","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,26]]}}}