Diagnosis

Pyuria >5 WBC per high-powered field on urine microscopy

OR

Positive leukocyte esterase as a surrogate

! The absence of pyuria strongly suggests an alternative diagnosis other than UTI

! Cloudy or malodorous urine is NOT diagnostic for UTI and should NOT be used as an indication for urine culture or antimicrobial therapy

Collect urine culture PRIOR to initiation of antimicrobial therapy whenever possible