00:00 – Dr. Nicholas Sanford: 60 to 80% of infections are biofilm related.
00:04 – So, I would say if you’ve got a biofilm producer in your
00:07 – sample, it likely came from a biofilm.
00:09 – Melissa: Hi. Welcome back to the Live UTI Free channel. My name
00:12 – is Melissa. And today I’ll be interviewing Doctor Nicholas Sanford,
00:16 – the vice president of medical affairs and the assistant lab director
00:19 – at MicroGenDX. We’ve collected many questions from our audience
00:23 – for this interview, and in part one, we’ll cover the differences
00:25 – between standard UTI tests in PCR and next generation sequencing
00:29 – tests. We’ll also discuss how and when to collect a urine sample.
00:33 – We have a lot of information about UTI testing on our website,
00:36 – so we’ll share some links in the video description. If you enjoy
00:39 – these videos, think they’re important, and want to support what
00:41 – we do, remember to hit subscribe and tick the bell so you get
00:44 – notified every time we post something new. Thanks again for joining
00:48 – us on this journey to making change in women’s health.
01:02 – Today I’m speaking with Doctor Nicholas Sanford, the vice president
01:05 – of medical affairs and assistant lab director at MicroGenDX. We
01:09 – find many requests from our community over the years to interview
01:11 – a scientist from MicroGenDX, and I’m very glad we’ve been able
01:14 – to organize this. Thank you for joining me to share your expertise.
01:19 – Dr. Nicholas Sanford: Thank you for having me. I’m very excited
01:20 – about this interview.
01:22 – Melissa: I’d love to hear more about your background and how you
01:25 – became interested in this area of research.
01:28 – Dr. Nicholas Sanford: Well, it’s kind of a funny story. I went to
01:32 – Texas Tech and I got a Bachelor’s Degree in Plant Biotechnology,
01:36 – and then I went directly into a PhD program studying the molecular
01:41 – biology of cotton fiber cell walls. After I graduated, well, I
01:47 – guess, a big part of my graduate project was sequencing ancestral
01:53 – cotton genomes and a lot of PCR work. So, after I graduated, I
01:57 – was looking for places that I could use those skills. And I stumbled
02:01 – across this little company called Path Genius. It’s located here
02:05 – in Lubbock, Texas. And it was owned by a wound care physician
02:08 – named Dr. Randall Wolcott. And he was very innovative in that
02:14 – he established a physician office lab where he was using molecular
02:18 – diagnostics, qPCR and Next-Gen Sequencing in order to diagnose
02:24 – and better treat these chronic wounds that he was seeing. So,
02:28 – I started working for the company as a bench technician. And over
02:32 – the years, I began designing a lot of the assays that we have,
02:36 – a lot of the PCR assays that we have on our menu. And in 2020,
02:41 – I designed our Covid assay, and I spent a lot of time on the phone
02:45 – with physicians and patients explaining how the assay works, the
02:49 – benefits and limitations of the assay. And that kind of transitioned
02:53 – me into this medical affairs role that I’m in now.
02:55 – Melissa: And can you give us some context for the types of tests
02:58 – that MicroGenDX currently offers?
03:01 – Dr. Nicholas Sanford: Absolutely. Well, the data from this qPCR
03:04 – plus NGS approach was so promising in wound care that it rapidly
03:08 – expanded to just about every other area of infectious disease.
03:13 – So, we’re doing testing on samples that can be collected from
03:16 – almost any body site for the purposes of diagnosing infections.
03:22 – So, we’ve done a lot of work over the years to validate all of
03:27 – these different sample types that we can accept in order to make
03:30 – this test accessible to the patients who need.
03:34 – Melissa: At this point in time, can you estimate roughly how many
03:36 – UTI tests you’ve processed?
03:39 – Dr. Nicholas Sanford: Oh, that I don’t know. I do know that urological
03:43 – samples are our highest volume tests. And we’ve done I mean, well
03:49 – over a million assays.
03:51 – Melissa: That’s a lot. And it’s probably one of the reasons we received
03:54 – so many questions about MicroGenDX testing, how it’s different
03:58 – to other types of UTI testing available. But I think it makes
04:01 – sense to first start with some of those other types so that we
04:03 – can talk about the differences in sensitivity. So, the first question
04:08 – is why are dipsticks so unreliable?
04:12 – Dr. Nicholas Sanford: Well, the dipsticks, I don’t wanna bash the
04:16 – dipstick too hard. The combined performance of leukocyte esterase
04:20 – and nitrites is a pretty good indicator for an accurate dipstick
04:25 – diagnosis. But those markers have limitations.
04:28 – Melissa: Mm-hmm.
04:29 – Dr. Nicholas Sanford: In your urine, you have chemicals called nitrates.
04:32 – And there are some bacteria that will convert these to nitrite.
04:35 – And that’s what’s measured with the nitrite test. The problem
04:38 – with it is some organisms don’t produce nitrites. So those would
04:41 – be missed in those scenarios. The other marker is leukocyte esterase
04:46 – which is an indicator of the presence of white blood cells. And
04:50 – most commonly the white blood cells in the urine are gonna be
04:53 – the result of an infection of some sort. But there are other things
04:57 – that can cause it. Prolonged use of aspirin, corticosteroids and
05:01 – diuretics could lead to elevated white blood cell count in the
05:05 – urine.
05:05 – Melissa: Mm-hmm.
05:05 – Dr. Nicholas Sanford: But I think, most importantly, neither one
05:07 – of those markers identifies an organism and helps you treat.
05:11 – Melissa: Yeah, I guess that takes us onto standard culture then.
05:14 – And why might that test be negative despite someone’s symptoms
05:18 – of UTI?
05:20 – Dr. Nicholas Sanford: Well, standard culture is predicated on having
05:22 – viable organisms to grow. And this sounds easy, but it’s not.
05:29 – There’s a lot of transport requirements after sample collection
05:32 – to get the sample to the lab in a certain amount of time, and
05:36 – then you have to set it up. And when you’re setting it up, you
05:39 – have to guess that what kind of media you wanna grow it on. Do
05:42 – you wanna look for aerobes, do you wanna look for anaerobes? How
05:46 – about fungi? Are you interested in acid fast bacilli? These are
05:49 – all different cultures that you have to run. And even if you’re
05:53 – running all of these things, we can still only identify about
05:55 – 2% of the bacteria we know of with these methods. So, because
05:00 – of that cultivation bias, we also know that standard urine culture
06:04 – is poor recovery of biofilms.
06:06 – Melissa: Mm-hmm.
06:06 – Dr. Nicholas Sanford: And just because some things just grow better
06:08 – in culture than others. And we also know that within the biofilm,
06:12 – some things are metabolically less active than others. And those
06:15 – might take a while to resuscitate and be out competed in the culture.
06:19 – So, I think there are these issues with it. A previous antibiotic
06:26 – exposure is another big reason why you might see a negative culture
06:31 – when you’re definitely have an infection going on.
06:34 – Melissa: Right. So, then the next step up from there is PCR testing.
06:38 – Can you explain what that is?
06:41 – Dr. Nicholas Sanford: So, PCR asks a very specific question and
06:45 – you can do a whole bunch of PCRs at one time to ask a bunch of
06:48 – specific questions. And these questions might be is Staphylococcus
06:53 – Aureus present in this sample? You could also ask is MecA present
06:57 – in this sample. And now you have a PCR that can detect MRSA, but
07:02 – it can’t tell you about anything else that might be in that sample.
07:06 – Melissa: Mm-hmm.
07:06 – Dr. Nicholas Sanford: Because you haven’t asked those questions.
07:08 – So, what PCR is doing is it’s amplifying specific pieces of DNA
07:13 – which are like fingerprints, basically. They are specific to an
07:19 – organism. And the way they’re doing this is we have DNA that’s
07:22 – been extracted from the sample that comes into the lab, and we
07:26 – combine that with short pieces of DNA called primers. And these
07:29 – bind to the genomic DNA in the sample to the target region. And
07:33 – then we have a DNA polymerase which is an enzyme that will stitch
07:38 – together the DNA in between the two primers and give you a PCR
07:41 – product. This method is incredibly sensitive, with a theoretical
07:46 – limit of detection of a single copy per ml, which is fantastic,
07:51 – but it’s got its limitations as well. Like I mentioned, if you
07:55 – don’t have primers for a certain organism, you’re gonna know nothing
07:58 – about it.
07:59 – Melissa: Mm-hmm.
07:59 – Dr. Nicholas Sanford: So, we call this panel bias. And there’s some
08:02 – studies that show the real world effect of panel bias. There’s
08:08 – an interesting one that was done by the Mayo Clinic where they
08:11 – compared their targeted NGS to the BioFire which is a PCR test.
08:17 – Melissa: Mm-hmm.
08:17 – Dr. Nicholas Sanford: And what they showed was that in real world
08:21 – samples, that PCR test had a sensitivity of about 56%.
08:26 – Melissa: Mm-hmm.
08:26 – Dr. Nicholas Sanford: Because it didn’t have things included on
08:28 – the panel that cause, in that case, periprosthetic joint infection.
08:33 – Melissa: Right.
08:34 – Dr. Nicholas Sanford: So I think, you know, another limitation could
08:38 – be mutations in the target and the targeted sequences. So if you’ve
08:42 – got mutations there, your primers aren’t going to match up and
08:45 – bind anymore. So that’s another limitation of this. I would say
08:50 – that PCR is significantly more rapid and sensitive than a standard
08:54 – culture, but it can’t detect as many organisms.
08:57 – Melissa: Can it detect organisms that were inside a biofilm?
09:01 – Dr. Nicholas Sanford: It can. So the detection of biofilm – molecular
09:05 – methods are really good at it because they’re not trying to grow
09:07 – anything.
09:08 – Melissa: Mm-hmm.
09:08 – Dr. Nicholas Sanford: We’re just breaking that sample open and looking
09:10 – at all the DNA that’s there. So, as long as you’ve sampled the
09:15 – biofilm, it can be detected with PCR or NGS.
09:19 – Melissa: I suppose that’s an issue for any test. If it’s not in
09:21 – the sample, you’re not gonna detect it.
09:24 – Dr. Nicholas Sanford: Correct.
09:24 – Melissa: So, after PCR is Next-Generation Sequencing or NGS, which
09:27 – is another type of technology that microGenDX uses. Can you explain
09:31 – the difference between PCR and NGS?
09:33 – Dr. Nicholas Sanford: So, if you’re asking questions, you’re asking
09:37 – very simple questions with PCR. NGS is asking a much broader question.
09:42 – Instead of is staph aureus here, NGS asks what bacteria are here?
09:48 – Melissa: Mm-hmm.
09:48 – Dr. Nicholas Sanford: And it also asks what is the relative abundance
09:52 – of each so you can figure out who’s dominating the mix. Maybe
09:57 – you’ve got a nice evenly dispersed mix that’s – you’ve got some
10:02 – high variability that looks reflective of your normal microbiome.
10:05 – So, it can ask those broader questions and the way that it’s answering
10:11 – those questions is by comparing a sequence to DNA to a large reference
10:16 – sequence database. There are a few different types of NGS. So,
10:21 – there’s targeted NGS. And then there’s metagenomic NGS –
10:25 – Melissa: Mm-hmm.
10:25 – Dr. Nicholas Sanford: Which is Whole Genome Sequencing. What we’re doing is targeted
10:29 – NGS and we’re targeting the 16S and 18S regions of bacteria and
10:34 – fungi in order to identify them. So, 16S and 18S are part of the
10:41 – ribosome RNA genes. And they’re very important to cell survival.
10:47 – So, they have regions in them that are called hyper conserved,
10:51 – meaning they don’t change over time. They don’t have a tendency
10:55 – to mutate because that would make problems for the cell. But in
10:59 – between, some of these hyper conserved regions are what we call
11:02 – hypervariable regions. And in here, the DNA is so different from
11:08 – species to species that you can actually use it as a fingerprint
11:11 – and identify them by that region. So, that’s kind of what we’re
11:16 – doing. But NGS has its limitations as well. For targeted NGS,
11:22 – we’re not gonna have full genome coverage. So, we don’t get any
11:25 – information about resistance genes. We don’t get strain level
11:29 – identification. But it is significantly more sensitive than PCR
11:34 – and culture. And our particular test is capable of detecting over
11:40 – 50,000 unique bacterial and fungal species.
11:44 – Melissa: Right. And we talked about whether these tests can pick
11:47 – up biofilms. What about for infections that are embedded within
11:50 – the bladder wall. Could NGS detect an infection like that?
11:54 – Dr. Nicholas Sanford: Absolutely. Again, it could but then this
11:57 – again is predicated on sampling the biofilm. So, as long as it’s
12:01 – contained in the sample then it’ll be able to detect it.
12:05 – Melissa: So, if cells from the bladder wall that contain bacteria
12:08 – are shed into the urine, then the test will be able to detect
12:11 – them.
12:12 – Dr. Nicholas Sanford: Absolutely.
12:13 – Melissa: Great. That’s good to know. And why do you use both PCR
12:18 – and NGS at MicroGenDX?
12:20 – Dr. Nicholas Sanford: So, we like the PCR because it provides a rapid result for some of the
12:27 – most common things that you see. It also gives us access to the
12:31 – antimicrobial resistance genes.
12:34 – Melissa: Mm-hmm.
00:12:34 – Dr. Nicholas Sanford: I mentioned we’re doing the targeted NGS which
12:36 – can’t see the resistance genes. So, the PCR helps complement that.
12:41 – Melissa: Right.
12:43 – Dr. Nicholas Sanford: PCR is also helpful because there are some
12:45 – instances with targeted NGS where you’re using 16S where certain
12:50 – species can’t be differentiated. So, we will also use the PCR
12:54 – panel there to break ties.
12:57 – Melissa: Okay. And so, why on your tests do organisms sometimes
13:01 – show up on PCR but not NGS and vice versa?
13:05 – Dr. Nicholas Sanford: Well, sometimes if the organism is found and
13:09 – it is something that’s included on our PCR panel, but the PCR
13:12 – seems to have missed it, what’s likely happening there is a mutation
13:17 – in the primer binding site, and this is another reason why we
13:20 – like to complement qPCR with NGS, because while qPCR might miss
13:26 – that because of the mutation, the NGS is looking at a different
13:30 – part of the genome and where it’s looking, it can pick it up.
13:34 – Also, it’s less prone to those mutation errors because it’s sequencing
13:39 – a large portion rather than do these three target binding sites
13:43 – match.
13:44 – Melissa: When you’re using PCR and the type of NGS that you utilize,
13:49 – what’s the chances that you’ll miss the organisms completely?
13:53 – Dr. Nicholas Sanford: Well, every test has a limit of detection.
13:56 – So, if it’s below the limit of detection, we’ll miss it.
14:02 – Other than that, I think the sensitivity of the PCR – PCR is incredibly
14:08 – sensitive with that limited detection. But also the discovery
14:13 – power of the NGS, I think if there’s something in that sample,
14:16 – this test is most likely gonna pick it up. There, of course, are
14:21 – situations where maybe there’s some kind of inhibitor in the sample
14:24 – that’s gonna prevent amplification.
14:26 – Melissa: Mm-hmm.
14:26 – Dr. Nicholas Sanford: Or if there was something maybe happened in
14:29 – shipping and the DNA was degraded enroute to the lab. Things like
14:34 – that happen occasionally.
14:37 – Melissa: Okay. And we got a couple of questions about specific organisms.
14:40 – You mentioned that your NGS database is about 50,000 organisms.
14:44 – Does that include the organism that causes Lyme disease?
14:49 – Dr. Nicholas Sanford: While it’s in the database, the regions that
14:52 – we’re sequencing are not optimal for Borrelia or other tickborne
14:58 – stuff. So, we don’t really advertise that we’re able to pick up
15:03 – Lyme disease or those infections. That is something that gets
15:07 – brought up to us a lot.
15:09 – Melissa: Mm-hmm.
15:09 – Dr. Nicholas Sanford: So, we’re always looking at
15:13 – ways to do it. But the biggest issue, doesn’t seem to be coming
15:17 – up with a PCR sequencing it, it’s how to collect a sample that’s
15:22 – gonna actually have the organism in it.
15:25 – Melissa: Yeah, I was wondering about that too, because from what
15:27 – I’ve read, that’s often within the bladder wall and not always
15:30 – in a urine sample, which is another layer of complexity.
15:34 – Dr. Nicholas Sanford: Mm-hmm.
15:35 – Melissa: And people also ask to what extent the tests can detect
15:38 – yeasts?
15:39 – Dr. Nicholas Sanford: Well, in our database we’ve got over 34,000
15:43 – fungal species but I don’t have the breakdown of yeast and mold.
15:48 – Melissa: Okay. That’s a lot though.
15:51 – Dr. Nicholas Sanford: It is.
15:52 – Melissa: And then, when it comes to detecting organisms that have
15:55 – been in a biofilm, is there a way to confirm that there is a biofilm
15:59 – in the bladder. And is that even helpful given that a healthy
16:02 – bladder also contains biofilms?
16:05 – Dr. Nicholas Sanford: It’s possible to demonstrate the presence
16:08 – of a biofilm, but those methods probably are still too cumbersome
16:11 – for routine clinical lab use. I would say that, in nature, biofilm
16:17 – is the preferred mode of growth of bacteria because of the protections
16:20 – that it affords. The NIH has even published a study claiming that
16:24 – 60 to 80% of infections are biofilm related.
16:29 – Melissa: Mm-hmm.
16:29 – Dr. Nicholas Sanford: So, I would say if you’ve got a biofilm producer
16:32 – in your sample, it likely came from a biofilm.
16:35 – Melissa: Right. Makes sense. And do you plan to provide STI testing
16:40 – that is using NGS or sticking with the PCR?
16:45 – Dr. Nicholas Sanford: Well, we’re always looking for ways to improve.
16:48 – Our targeted NGS is only targeting the bacterial and fungal species,
16:52 – so the PCR can help us with parasites and viruses like trachomatis
16:56 – or HSV. It also gives us the antimicrobial resistance genes. But
17:02 – we’re sequencing labs, so we’ve invested in all of the new technology.
17:08 – We’ve got the long read and the short read sequencers. So, I think
17:12 – it’s certainly possible that a metagenomic offering to provide
17:16 – very detailed information on STIs could be on our menu in some
17:20 – fashion in the future.
17:21 – Melissa: I’m sure a lot of people will be interested to hear that.
17:24 – Now that we’ve talked about these types of tests, why is it that
17:27 – they’re not generally covered in guidelines for clinical practice?
17:32 – Dr. Nicholas Sanford: Well, to get into the guidelines, you’ve got
17:34 – to have an overwhelming amount of clinical evidence. And I think
17:39 – the IDSA signaled that we’ve hit that point recently with their
17:42 – update to their guideline which is now recommending NGS for a
17:47 – large swathe of different infection types. Unfortunately, urology
17:51 – was left out. The editors of that section simply referred readers
17:56 – to the AUA guidelines. So,
18:01 – what we’ve got going on there is there is a petition on Change.org
18:08 – written by a Ms. Carrie Anne to make advanced testing like this
18:14 – part of the AUA guidelines. And that petition is doing very well.
18:18 – It’s got over 31,000 signatures with a goal of 35,000.
18:22 – Melissa: Right.
18:23 – Dr. Nicholas Sanford: So, if people could reach out and sign that
18:26 – petition, that would certainly help move this technology into
18:31 – the guidelines.
18:32 – Melissa: Yeah, I can drop the link in the video description for
18:34 – anyone who’s interested.
18:37 – Well, we’ve spoken a bit about whether an organism is in a sample,
18:42 – so I think it’s a good time to start talking about how to collect
18:44 – a good sample for a MicroGenDX test. And can you first describe
18:49 – what a MicroGenDX test includes?
18:52 – Dr. Nicholas Sanford: Sure. So, if you’re ordering the UTI kit,
18:55 – it’s gonna come with a 90 ml cup in a biobag. The vaginal kits
19:00 – are going to come with two dry flocked swabs in the biobag, and
19:03 – the prostate kits come with a 90 ml cup and one flocked swab with
19:08 – the biobag. Occasionally, if you feel like maybe you’ve had an
19:14 – error in collecting your samples, reach out to us before sending
19:17 – it in and we can replace those collection supplies for you.
19:21 – Melissa: A couple of people did ask about that whether you send
19:23 – back ups in case the error happens during collection, or sometimes
19:27 – people will collect a sample and then their symptoms will get
19:30 – worse and they’ll want to recollect because it seems like a better
19:33 – time. So, it’s good to know they can reach out for a replacement
19:36 – if needed. And what’s the benefit of the combined urine and vaginal
19:41 – swab test?
19:43 – Dr. Nicholas Sanford: Well, I guess just that it’s gonna give you
19:45 – more information. We see a lot of people running these paired
19:48 – samples together. And it’s not uncommon to see different organisms
19:53 – in the different body sites. So, I think it’s certainly helpful
19:58 – in just giving you more information, but it might also be helpful
20:01 – in cases where you’ve got inconsistent or unlocalized symptoms
20:05 – and you’re not sure where the sample might be best taken.
20:09 – Melissa: Is that then the case with prostate test alongside a urine
20:13 – test as well?
20:14 – Dr. Nicholas Sanford: I would say so.
20:16 – Melissa: Okay. Do you think for a female who experiences recurrent
20:20 – or chronic UTI, that it makes sense for a male partner to also
20:23 – get tested?
20:25 – Dr. Nicholas Sanford: Absolutely. Yeah. I mean, I think it’s certainly
20:30 – feasible that we serve as reservoirs to one another. I mean, we
20:34 – spread infections to each other all the time.
20:36 – Melissa: Mm-hmm.
20:36 – Dr. Nicholas Sanford: So, spreading infections like this, it makes
20:39 – perfect sense to me.
20:41 – Melissa: I’ve seen more clinicians take that approach because we
20:44 – have had a lot of pushback on that suggestion over the years.
20:48 – Dr. Nicholas Sanford: I mean, it’s hard to say. I don’t see what’s
20:53 – coming through on the day to day. And, oftentimes we don’t know
20:56 – if people are related or not. We get a sample and a little bit
21:02 – of information about the patient so.
21:06 – Melissa: Yeah. That makes sense. We do have an interview on our
21:09 – channel with Dr. Tim Hlavinka who talks a lot about this topic,
21:11 – and partners who may be transferring organisms and when to test
21:15 – so people can refer to that too for more information. Is it best
21:18 – to collect a sample when symptoms are present? And for people
21:21 – who have continuous symptoms, should they wait until their symptoms
21:24 – are worse than they are usually to collect their sample?
21:28 – Dr. Nicholas Sanford: I would say it’s generally recommended to
21:30 – collect samples when your symptoms are present. And I would say
21:34 – first thing in the morning because those samples are going to
21:37 – be more concentrated. If you’re having continuous or chronic symptoms,
21:41 – I wouldn’t wait for things to get worse. I would just collect
21:44 – samples when you’re experiencing representative symptoms.
21:48 – Melissa: Okay. And so, you mentioned collecting in the morning if
21:50 – possible. Do you require a midstream sample or is there something
21:54 – else that you recommend?
21:56 – Dr. Nicholas Sanford: Midstream is most common. And it works well
22:00 – when the collection instructions are strictly followed. So, like
22:04 – if you think you contaminated the sample, you probably did. It’s
22:07 – time to reach out and get new supplies.
22:10 – Melissa: That’s yeah, a good approach, I think. And if someone has
22:14 – taken antibiotics, how long should they wait before collecting
22:16 – a sample?
22:18 – Dr. Nicholas Sanford: We recommend waiting about 48 hours after
22:21 – you finish to collect a new sample. If for any reason you can’t
22:26 – do that, we can still process the sample while you’re on antibiotics.
22:31 – Melissa: Is that the same advice for someone who’s been on antibiotics
22:33 – for a long time, say six months to a year? Or would you recommend
22:37 – that they wait for longer?
22:40 – Dr. Nicholas Sanford: Our current recommendation is 48 hours, simply
22:43 – because we haven’t done that kind of study to determine if there
22:46 – is a longer period that it needs to be. But I think we certainly
22:52 – don’t see a certain population who is having a higher negative
22:57 – rate because of that.
22:59 – Melissa: Okay. And for people who are on long term antibiotics and
23:03 – have breakthrough symptoms, can they collect a sample at that
23:06 – point? And how will the antibiotics affect that?
23:10 – Dr. Nicholas Sanford: They can collect a sample. The antibiotics
23:13 – shouldn’t affect it too terribly. There are two studies out there
23:16 – that I’m aware of – one was done in our lab and one wasn’t – that
23:21 – show the effect of previous antibiotic exposure on test positivity.
23:26 – And
23:28 – we run some biomarkers for our ortho tests, and all of those are
23:33 – impacted by antibiotics, but the NGS is not.
23:36 – Melissa: Mm-hmm.
23:36 – Dr. Nicholas Sanford: The other study looked at a wide variety of
23:41 – sample types. And they looked at previous antibiotic exposures
23:45 – and they saw the same thing. The cultures were significantly impacted,
23:49 – but NGS test positivity remained strong.
23:53 – Melissa: Okay. Interesting. And do you make the same recommendations
23:56 – about the 48 hours for urinary antiseptics like hiprex or methylamine?
24:01 – Dr. Nicholas Sanford: Yes.
24:02 – Melissa: Okay, that’s good to know because a lot of people are on
24:05 – methylamine now. And it’s a question that we get quite frequently.
24:09 – And some clinicians recommend taking a biofilm disrupter prior
24:13 – to testing. Have you seen any benefit to this or any change in
24:17 – the results?
24:19 – Dr. Nicholas Sanford: This isn’t something that we’ve studied in
24:21 – detail at our laboratory, but the research available seems to
24:25 – suggest that they certainly enhance the detection of biofilm related
24:30 – organisms.
24:31 – Melissa: Do you think there’s any benefit in testing when UTI symptoms
24:34 – are not present for someone who experiences recurrence?
24:38 – Dr. Nicholas Sanford: Absolutely. I think testing your microbiome
24:40 – during these symptom-free periods can provide an idea of the normal
24:44 – state of things. It can also show what kind of shifts might happen
24:48 – because of changes in your diet or medications you’re taking,
24:51 – and I’m sure many other things. I would like to point out that
24:55 – our test is not a microbiome test. It is a clinical diagnostic
24:59 – intended for detecting infection. So, that’s why like we often
25:06 – get questions like I did a microbiome test and I did a microGen,
25:09 – why don’t your results match up? And it’s because we’re doing
25:13 – different things.
25:14 – Melissa: Mm-hm. Fair enough. And you have a lot of international
25:17 – patients. How does the transit time of a sample impact the results?
25:22 – Dr. Nicholas Sanford: So, most of the sample types that we accept
25:25 – are viable for 21 days at room temperature. They don’t need to
25:30 – be refrigerated or frozen prior to shipping. But if, for any reason
25:35 – you collect a sample and you store it in the refrigerator or freezer,
25:38 – we do recommend shipping it on ice, because when you go through
25:42 – repeated freeze-thaw cycles that can degrade the DNA in the sample.
25:46 – Melissa: Okay.
25:47 – Dr. Nicholas Sanford: I will also say that because we’re talking
25:50 – UTIs, if you’re gonna send a urine sample and you’ve ordered the
25:54 – biomarker UA portion add on to that test, then we need
25:58 – to receive it within 72 hours because time and shipping will impact
26:02 – biomarker results.
26:03 – Melissa: Right. And for someone who is not doing the UA
26:06 – part of the tests and collects on a Friday, is it best to just
26:10 – leave it at room temperature and ship it on a Monday?
26:13 – Dr. Nicholas Sanford: Yes.
26:14 – Melissa: Okay. That’s good to know. I think the assumption would
26:17 – usually be that it’s better to put it in the fridge, but it sounds
26:19 – like that is not the case.
26:22 – Dr. Nicholas Sanford: I mean, like, it’s something that we get asked
26:25 – about a lot. So, we’ve done these studies and we’ve done them
26:28 – at zero like at freezing. We’ve done them at a 100 degrees.
26:34 – Melissa: Dr. Nicholas Sanford: And it seems like we don’t see any change
26:38 – in the bacterial load or the relative abundances up until after
26:44 – 21 days.
26:45 – Melissa: Okay. That’s quite a long time. Surprising.
26:48 – Dr. Nicholas Sanford: It is.
26:49 – Melissa: Thanks so much for watching. I hope part one of this interview
26:52 – helped to add to your knowledge about UTI testing. If you’d like
26:55 – to learn more about this or related topics, be sure to check out
26:57 – our other videos or head over to liveutifree.com for more info.
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27:09 – so much for watching. And until next time, keep asking questions
27:12 – and pushing for better solutions.