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Bacteriologic diagnosis of complicated, recurrent UTIs and of asymptomatic bacteriuria is usually based on the concept of clinically important bacteriuria, which for these patients is usually defined as > 105 CFU/mL in a midstream urine sample after > 4 hours of bladder incubation. For women with uncomplicated symptomatic cystitis, however, the highest diagnostic sensitivity and specificity are achieved when clinically important bacteriuria is defined as > 102 CFU/mL with pyuria. If the clinical importance of bacteriuria is doubtful (eg, when repeated samples yield more than one bacterial strain) and obtaining culture is critically important, urine may be obtained by bladder puncture.