URINARY TRACT INFECTION AND SEPSIS
LEARNING OBJECTIVES :
KNOWLEDGE - Students should be able to describe:
- The signs and symptoms, in women, of the following: cystitis, urethral syndrome, vaginitis, estrogen deficiency changes, genital herpes.
- The signs and symptoms, in men, of the following: urethritis, cystitis, prostatitis, genital herpes, balanitis.
- The signs and symptoms of pyelonephritis.
- The bacteria that most commonly cause UTI.
- The definition of uncomplicated vs. complicated (those arising in a setting of catheterization, instrumentation, urologic functional or anatomic abnormalities, stones, obstruction, immunosuppression, renal disease or diabetes) infections.
- Predisposing factors including gender, sexual activity, pregnancy, barrier contraceptives (diaphragm) and spermicides, male homosexuality, obstruction, lack of circumcision.
- The indications for diagnostic tests, including: urinalysis, urine culture and sensitivities, intravenous pyelogram, voiding cystourethrogram, renal ultrasound.
- The choice and duration of therapy for uncomplicated and complicated urinary tract infections.
Students should be able to:
- History-taking: obtain, document and present an age-appropriate history that distinguishes cystitis and non-cystitis causes of dysuria, including a sexual history, and upper from lower tract infections.
- Physical Exam: percuss the back for costovertebral angle tenderness (CVAT), percuss and palpate the bladder, exam of the male urethra with expression of discharge, prostate massage, perineal/vaginal exam for atrophy, inflammation and balanitis.
- Laboratory: interpret the results of a urinalysis including leukocyte esterase, WBC's and RBC's, epithelial cells, urine gram stain, gram stain of urethral discharge, urine culture, vaginal discharge microscopic exam (KOH, NaCl), and post-void urine residual.
- Procedural: proficiently perform a urinary catheterization, urinalysis with microscopy, gram stain of urine and urethral discharge, saline and KOH preps.
- Communication: educate and counsel patients regarding the role of sexual activity in UTI's, communicate the diagnosis and explain the treatment plan.
- Management: select appropriate antibiotic therapy prior to culture results and select the duration of therapy for the type of infection.
ATTITUDES AND PROFESSIONAL BEHAVIORS:
- Students should appreciate the discomfort associated with dysuria and be sensitive to the issues regarding the patient's sexual activities.
- Stamm W. Urinary tract infections and pyelonephritis. Harrison's Principles of Internal Medicine. McGraw Hill. Online address: (through Loyola University Medical Center's Health Sciences Library) http://www.harrisonsonline.com/subscr_main.html B updated continuously.
- Stamm WE, Hooton TM. “Management of urinary tract infections in adults.” N Engl J Med 1993; 329: 1328-1334.
- Hooton TM, Stamm WE. “Diagnosis and treatment of uncomplicated urinary tract infection.” Infectious Disease Clinics of North America 1997; 11: 551-581.
- Kalpana Gupta, Thomas M. Hooton, and Walter E. Stamm “ Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infection s”
Ann Intern Med , Jul 2001; 135: 41 - 50.