Urinary tract infection is a common ailment, especially among women. This condition is characterized by symptoms such as lower abdominal pain, increased frequency of urination, painful urination, and occasionally, blood in the urine.

To establish the diagnosis of a urinary tract infection, in addition to patient history and physical examination, laboratory tests and imaging are necessary.

The laboratory tests that can be performed are as follows:

• Urinalysis The diagnosis of an infection can be confirmed when pyuria is present, characterized by:
  • Positive leukocyte esterase
  • High leukocyte count Other findings might include:
  • Hematuria in some cases of urinary tract infection
  • Proteinuria, which can be observed in infection cases; however, proteinuria exceeding 2 grams per 24 hours indicates glomerular disease
  • Positive nitrite test. Nitrite is a product produced by various bacteria. Normally, nitrite is not found in urine unless an infection is present.
• Urine Specimen: The urine specimen can be obtained from midstream clean catch urine, catheterization procedures, or suprapubic aspiration. Properly collected midstream urine yields accurate results. Female patients should open the labia with one hand, cleanse with the other hand, allow a small amount of urine to pass first, and then collect the midstream urine. This method minimizes contamination of the urine sample.
• Urine Culture Examination Urine culture examination is the standard for diagnosing urinary tract infections. According to the Infectious Disease Society of America (IDSA) consensus in 2010, a urinary tract infection in women is diagnosed when there are more than 1000 CFU/ml (colony-forming units per milliliter). Not all cases require urine culture examination unless there is empirical therapy failure. If a patient experienced an infection 1 month ago and is experiencing a relapse, it's likely caused by the same bacteria. Relapse indicates empirical therapy failure. On the other hand, reinfection occurring within 1-6 months is caused by different bacteria. Urine culture is necessary for patients experiencing reinfection.
  Urine Specimen: The urine specimen for culture can be obtained from midstream clean catch urine and should be collected in a clean and sterile container.
• Ultrasound Examination (USG) Ultrasound examination of the kidneys and urinary tract is aimed at detecting signs of inflammation in the bladder area. This examination can also identify structural abnormalities.

EXAMINATION PREPARATION Before the examination, patients are asked to fast for approximately 6 hours, drink plenty of water (about 3-4 glasses of mineral water), and refrain from urinating for at least 1 hour prior to the examination to ensure a full bladder.

Author: Dr. Clarinda Hermanto (Medical Consultant at PRAMITA Laboratory Medical Center, Branch at Jl. Bambang Sugeng No. A2 Magelang)