New urine test shows which UTI antibiotic works in under six hours

A new direct-from-urine test could help doctors choose the right antibiotic for UTIs on the same day, potentially improving patient outcomes while reducing delays that can fuel resistance and serious complications.

Patients with urinary tract infections (UTIs) could receive the right antibiotic far sooner, thanks to a new test that produces results within hours rather than days. 

Researchers at the University of Reading, working with colleagues at the University of Southampton and Hampshire Hospitals NHS Foundation Trust, have shown that a novel method testing directly from urine can tell doctors which antibiotic will work in an average of 5.85 hours. Standard laboratory testing currently takes two to three days. 

The study, funded by the National Institute for Health and Care Research (NIHR), published in the Journal of Antimicrobial Chemotherapy, tested 352 urine samples from patients with suspected UTIs. The new test agreed with the reference method in 96.95% of cases for the seven first-line antibiotics used to treat UTI. Crucially, a second study of 90 duplicate samples showed 98.75% agreement for direct-from-urine testing when collecting and storing urine samples with and without a preservative. 

Dr Oliver Hancox, Chief Executive Officer of Astratus Limited, the University of Reading spin-out company that will take the test to market, said: "By the time the laboratory delivers the result under current methods, a patient may already have finished their antibiotics, or been given ones that do not work. 

"Being able to tell a doctor the same day which antibiotic to use means the patient gets the right treatment sooner, reducing the risk of resistance developing and their infection turning into potentially lethal sepsis." 

Professor Mike Lewis, NIHR Scientific Director for Innovation, said: "This NIHR-funded research not only has the potential to deliver quicker, more effective treatments to patients suffering with UTIs - but also tackles the broader challenge of antimicrobial resistance. The rapid urine test is a fantastic example of the real-world solutions to AMR that the government committed to developing in its 10-Year Health Plan." 

UTI Burden and Antibiotic Resistance Pressure

NHS data shows that UTIs have led to more than 800,000 hospital admissions across England over the past five years, and a quarter of urine samples analysed in NHS laboratories contained bacteria resistant to commonly used antibiotics. Approximately 65 million urine samples are tested annually in the UK alone. 

Under current methods, a urine sample must be cultured overnight so the bacteria can grow and be identified before any antibiotic testing begins, a process that can take two to three days in total. 

Direct-From-Urine UTI Testing Method

This new test skips the overnight step entirely and involves simple sample processing. A cartridge of fine tubes, each preloaded with a different antibiotic, is dipped directly into the sample and then loaded into an instrument. Optical imaging then tracks whether bacterial growth is detected or not in each tube. If growth is blocked, that antibiotic works against the infection. If bacteria continue to grow, they do not. This tells doctors which drug to prescribe, in under six hours. 

Professor Matthew Inada-Kim, a consultant acute physician and AMR Lead at Hampshire Hospitals NHS Foundation Trust, and researcher at the University of Southampton, said: "UTIs are a common reason that patients need antibiotics, and getting the right treatment first time could be a lifesaver. 

"A test that works on samples we already collect as standard, and gives us answers the same day, is exactly the kind of tool that could change how we manage these infections in practice." 

Clinical Study Validation and Preservative Testing

In the study, 352 urine samples already collected as part of routine laboratory testing at Basingstoke and North Hampshire Hospital were used to assess the overall accuracy of direct-from-urine testing. To evaluate whether the use of boric acid preservative, routinely used when collecting and storing urine samples, affected results, 90 fresh samples from the hospital emergency department were split into two duplicate sets, and boric acid was added to one set. Results agreed in 98.75% of cases, showing that the preservative does not affect result accuracy. This is the first study to directly compare urine samples with or without boric acid to assess the impact of the preservative on a rapid direct-from-urine method. 

The study marks an important milestone for Astratus Limited, the University of Reading spin-out company founded in November 2024 by the research team behind the test.