Diagnostic tests for urinary tract infections and antimicrobial resistance—a reality check between diagnostic innovation and implementation: a critical narrative review

Urinary tract infections (UTIs) are a significant health concern worldwide, leading to substantial health and economic burden and contributing to the rise of antimicrobial resistance (AMR). Although there has been significant advancement in diagnostic technologies starting from conventional dipstick urinalysis to molecular assays and artificial intelligence (AI)-supported platforms, their clinical utility and impact still remain unclear. This is fundamentally due to the systemic barriers that hinder the implementation including cost, policy, and limitations to integrate into frontline healthcare and adoption by insurance agencies. This review focuses on critically reviewing UTI epidemiology, current and emerging diagnostics, and their significance in antimicrobial stewardship. We emphasise that bridging the gap between diagnostic innovation and clinical practice is essential to achieving meaningful milestones in AMR reduction. We are primarily arguing that addressing the policy inertia to diagnostic deployment with stewardship strategies is a crucial step for improving patient healthcare outcomes and preserving antimicrobial efficacy.