Episode 995: UTI Diagnosis

Accurate diagnosis of urinary tract infections (UTIs) requires the presence of localizing symptoms—such as dysuria, urgency, or suprapubic pain—and a urinalysis showing more than 10 white blood cells per high-power field. Contrary to common clinical assumptions, foul-smelling or cloudy urine are not diagnostic criteria and often lead to the overtreatment of asymptomatic bacteriuria. A 2017 review found that 45% of patients treated for UTIs actually had asymptomatic colonization, a practice that disrupts the gut microbiome, risks adverse drug reactions, and increases multi-drug resistance. Misdiagnosing colonization as an active infection also creates a "diagnostic overshadowing" risk, where providers attribute symptoms to a UTI while missing critical conditions like strokes or myocardial infarctions. While rapid urine collection in the emergency department improves throughput efficiency, clinicians must balance this with the risk of over-testing and unnecessary antibiotic exposure.