Vol. 7, Issue 2, Part A (2025)

Background: Urinary tract infection (UTI) is one of the most common bacterial infections among women, yet distinguishing true bacterial infection from culture-negative symptomatic cases remains challenging. This study evaluated the diagnostic performance of urinalysis, microscopy, and systemic inflammatory biomarkers in women with suspected UTI.

Methods: A cross-sectional study was conducted at Maysan General Hospital, Iraq, from September 2024 to June 2025. One hundred twenty adult female patients were enrolled: 80 with culture-confirmed UTI and 40 with negative cultures. Urinalysis (leukocyte esterase, nitrite, blood), urine microscopy, and serum biomarkers (routine C-reactive protein [CRP], CRP-ELISA, and Serum Amyloid A [SAA]) were assessed. ESBL production in Escherichia coli isolates was determined using the combined disk synergy test.

Results: Nitrite and leukocyte esterase were significantly higher in culture-positive cases (p < 0.05). Mean urinary WBC and bacterial density differed markedly between groups (p < 0.001). Serum CRP, CRP-ELISA, and SAA were all significantly elevated in culture-positive patients (p < 0.0001). ESBL-producing E. coli accounted for 32.5% of isolates.

Conclusion: Combining dipstick and microscopy with inflammatory biomarkers enhances diagnostic accuracy for UTI in symptomatic women. The high prevalence of ESBL-producing E. coli highlights the need for rapid diagnostics and antibiotic stewardship in Iraqi healthcare settings.