DIAGNOSTIC AND THERAPEUTIC APPROACH TO URINARY TRACT INFECTIONS IN ADULTS: AN EVIDENCE-BASED UPDATE

Abstract

Urinary tract infections (UTIs) are among the most prevalent infectious diseases in clinical practice, representing a significant cause of morbidity and recurrent use of antimicrobials. This study aims to critically review the most recent scientific evidence regarding the diagnostic and therapeutic approach to UTIs in adults, with an emphasis on updating evidence-based practices. This is an integrative literature review conducted in the PubMed, SciELO, LILACS, ScienceDirect, and Scopus databases, covering publications between 2015 and 2025. Forty-two studies addressing diagnostic methods, therapeutic strategies, and clinical guideline recommendations were included. The results showed that clinical diagnosis, associated with laboratory tests such as urine culture and rapid screening tests, remains fundamental for etiological confirmation and risk stratification. Recent advances include the use of biomarkers and molecular techniques that increase diagnostic accuracy and reduce the inappropriate empirical use of antibiotics. In treatment, a trend towards therapeutic rationalization was observed, prioritizing narrow-spectrum antimicrobials such as nitrofurantoin and fosfomycin, in addition to an emphasis on prevention strategies and rational antimicrobial use programs. It is concluded that the contemporary approach to UTIs in adults should be individualized, multidimensional, and based on updated evidence in order to optimize clinical management, reduce complications, and contain the advancement of bacterial resistance.