What are the recommended diagnostic criteria for urinary tract infections in adult patients presenting with typical symptoms?

Recommended Diagnostic Criteria for Urinary Tract Infections (UTIs) in Adult Patients Presenting with Typical Symptoms:

• Clinical symptoms and signs suggestive of UTI include: painful urination (dysuria), increased frequency of urination, new onset of bedwetting, foul-smelling urine, darker or cloudy urine, visible blood in urine (frank haematuria), fever, shivering, abdominal pain, loin or suprapubic tenderness, and a previous history of confirmed UTI.
• Diagnosis is primarily clinical: The presence of multiple typical symptoms and signs increases the likelihood of UTI and supports the decision to test urine.
• Urine testing: Urine dipstick testing for leukocyte esterase and nitrite is diagnostically useful and can be used safely to support diagnosis. A positive dipstick test supports the diagnosis of UTI, while both leukocyte esterase and nitrite negative results suggest UTI is unlikely and antibiotics should not be given.
• Urine culture: Should be sent if there is suspicion of upper UTI (pyelonephritis), high risk of serious illness, recurrent UTI, or if symptoms do not respond to treatment within 24–48 hours.
• Clinical judgement: Should be used alongside urine testing results, as symptoms alone or dipstick results alone may not be definitive.

These criteria are based on symptom assessment combined with urine dipstick testing, with culture reserved for specific clinical scenarios to confirm diagnosis and guide management.

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