Recommended Diagnostic Criteria for Urinary Tract Infections (UTIs) in Adults Presenting with Typical Symptoms
In adults, particularly women aged 16 years and over, the diagnosis of a suspected lower urinary tract infection (UTI) is primarily clinical, based on typical symptoms such as dysuria (painful urination), increased urinary frequency, urgency, and suprapubic pain. The presence of these symptoms increases the likelihood of UTI.
Urine dipstick testing for leukocyte esterase and nitrites can support the diagnosis but is not always required if symptoms are typical. A positive dipstick test for leukocyte esterase or nitrites increases the likelihood of UTI, while both being negative makes UTI unlikely.
Urine culture and sensitivity testing is recommended if symptoms worsen rapidly, do not improve within 48 hours of treatment, or if there are risk factors for complicated UTI, recurrent infections, or catheter use. In uncomplicated cases with typical symptoms, empirical treatment may be started without immediate urine culture.
Severe systemic symptoms or signs suggesting complications such as pyelonephritis or sepsis warrant urgent hospital admission and further investigation.
Asymptomatic bacteriuria should not be routinely treated in non-pregnant adults.
In summary, the diagnosis relies on typical clinical symptoms supported by urine dipstick testing when appropriate, with urine culture reserved for complicated or atypical cases.
References: NICE CKS