Session I K. G. N a b e r

Characteristics of Patients with Urinary Tract Infections Since the various types of urinary tract infections (UTI) differ as to treatment and prognosis, in clinical studies it is necessary to characterize the clinical situation of patients as accurately as possible, e.g. to analyse the comparability of investigated groups. The working group "Urinary Tract Infections" of the Paul-Ehrlich-Gesellschaft fiir Chemotherapie e.V. has developed a systematic catalogue of relevant characteristics, because it may be of help if terminology and classification are used according to generally accepted rules. It was believed, that before a patient's UTI is classified as, e.g. complicated or uncomplicated - as acute cystitis or pyelonephritis, respectively - the documentation should make clear the .clinical symptoms, laboratory findings and additional investigations on which a specific diagnosis was based. At the same time, the catalogue allows documentation of the level of certainty at which a specific kind of UTI has been diagnosed. Furthermore, in the treatment of complicated LrrI, chemotherapy and urological interventions are usually complementary. This interrelationship should be carefully documented according to time and nature of intervention. Whether, for example, a relevant obstruction could be removed or not is of great prognostic importance. The catalogue lists as many characteristics as are available. The final classification of the nature of a particular LrI'I is made according to "severity" in a hierarchical manner, i.e. if several classifications could be applied, the most severe diagnosis is chosen. Since the different characteristics can be coded, it also appears possible to generate a specific diagnosis retrospectively. This may be necessary if, for example, two studies are to be compared. The working group would like to present the following catalogue as a subject for discussion. As a next step, a practical questionnaire should be developed to facilitate its clinical use.

I. Relevant Concomitant Conditions (Risk Factors) 1.0 1.1 1.1.t 1.2 1.2.1 1.2.2 1.2.3 1.3 1.3.1 1.3.2 1.3.3 1.4 1.5

No data Metabolic disorders Diabetes mellitus, etc. Immune defect Inborn Acquired, e.g. HIV Immunosuppressant therapy Relevant remote infections Cerebrospinal Pulmonary Intraabdominal Mental status Sexual factors, birth control, menopause

pregnancy, parity,

1.6 i.6.1 1.6.2 1.6.3 1.9

External risk factors Environment, e.g. ICU, nursing home Medication, e.g. hormones Operative conditions, e.g. duration, blood loss No relevant risk factors

2.0 2.1 2.2

No data First infection

II. Manifestations

2.2.0 2.2.1 2.3 2.3.0 2.3.1 2.3.2 2.4

2.5 2.5.0 2.5.1 2.5.8 2.5.9

Clinical recurrence (how often?) - occurrence in

previous twelve months: No recurrence in previous twelve months, One recurrence in previous twelve months, etc. Clinical persistence

Previous treatment not known No previous treatment with antibiotics Previous treatment with antibiotics (which?) UTI diagnosed as an outpatient UTI diagnosed in a hospital

patient (time of occurrence?) During hospitalization On first day in hospital, etc. On eighth day in hospital, or later During hospital stay, time of occurrence not known

IIl. Clinical Symptoms 3.0 3.1

No data No previous treatment

3.2

Previous, or ongoing, treatment

3.2.0 3.2.1 3.2.2 3.2.3 3.2.4 3.3 3.3.1 3.3.2 3.3.3 3.4 3.4.t 3.4.2 3.4.3

Previous, but unknown, treatment Antibiotics (which ones?) Analgesics Diuretics Other relevant concurrent medication Micturition disturbances

Painful micturition Frequent micturition Urinary urgency Pain in region of lower urinary tract

Perineal pain Urethral pain Pain in bladder region

3.5

Symptoms in the region of the upper urinary tract

3.5.1 3.5.2 3.5.3 3.5.4 3.5.5

Unilateral flank pain Bilateral flank pain Unilateral sensitivity to palpation and pressure Bilateral sensitivity to palpation and pressure Back pain

3.6

General symptoms

3.6.1 3.6.2 3.6.3 3.6.4 3.6.5

Fever Chills Tachycardia Hypotension Rigors

Prof. Dr. med. K. G. Naber, UrologischeKlinik, Elisabeth Krankenhaus, Schulgasse 20, W-8440 Straubing, Germany.

Infection 20 (1992) Suppl. 3 © MMV Medizin Vertag GmbH Miinchen, Mtinchen 1992

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K. G. Naber: Characteristics of Patients with UTI 3.7 3.7.1 3.7.2 3.7.3 3.7.4 3.7.5 3.9

4.5.9 4.6 4.6.0 4.6.1 4.6.2

Symptoms of sepsis Skin Circulation Pulmonary Cardiac Coagulation disturbances No clinical symptoms (asymptomatic)

IV. Pathological Changes in Urinary Tract 4.0 4.1 4.1.0 4.1.1 4.1.2 4.1.3 4.1.4 4.1.5 4.1.6 4.1.7 4.1.8 4.1.9 4.2 4.2.0 4.2.1 4.2.2 4.2.3 4.2.4 4.2.5 4.2.6 4.2.8 4.2.9 4.3 4.3.0 4.3.1 4.3.2 4.3.3 4.3.4 4.3.5 4.3.9 4.4 4.4.0 4.4.1 4.4.2 4.4.3 4.4.4 4.4.5 4.4.9 4.5 4.5.0 4.5.1 4.5.2 4.5.3 4.5.4 4.5.5 4.5.6 4.5.7

4.5.8

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No data Anatomical changes in upper urinary tract No details known Unilateral changes Bilateral changes Scarring Urinary stasis (cause?) Urolithiasis (site?) Vesicorenal and/or vesicoureteral reflux (grade?) Tumour (what type?) Renal transplant No pathological changes in upper urinary tract Anatomical changes in urinary bladder No details Bladder calculi Bladder diverticulum Bladder tumour Intrusion of tumour into bladder Foreign body Artifical bladder and/or conduit Other No pathological changes to urinary bladder Anatomical changes to vesical neck No details known Prostatic adenoma Prostatic carcinoma Stenosis of vesical neck Prostatic abscess Other No pathological changes to vesical neck Anatomical changes to urethra No details Stricture (where?), including stenosis of the urethral meatus, phimosis Diverticulum Anomalies Tumour Other No pathological changes to the urethra Changes outside the urinary tract which affect the urinary tract No details known Pregnancy Retroperitoneal tumour Retroperitoneal fibrosis Colonic diverticulitis Genital anomalies Genital tumours (what type?) Status following surgery which may result in anatomical displacement of the urinary tract, e.g. removal of the rectum, hysterectomy, Wertheim's operation Treatment which may result in anatomical displacement of the urinary tract, e.g. radiation of the pelvis

4.6.9 4.7 4.7.0 4.7.1 4.7.2

4.7.3 4.7.9 4.8 4.8.0 4.8.1 4.8.1.1 4.8.1.2 4.8.1.3 4.8.1.4 4.8.2 4.8.2.1 4.8.2.2 4.8.2.3 4.8.2.4 4.8.2.6 4.8.2.7 4.8.9 4.9

No relevant changes outside the urinary tract for UTI Functional changes to the urinary tract No details known Upper urinary tract, e.g. megaloureter In the lower urinary tract region (e.g. irritable bladder, incontinence, sphincter, detrusor dyssynergia) No functional changes to the urinary tract Neurogenic disturbances of function No details known Function largely normal, with no residual urine, with and without incontinence Flaccid paralysis of the bladder due to!oss of spinal cord control centre, voiding achieved by intermittent catheterization by the patient or by straining Paralysis of bladder with loss of central bladder control centres, associated with reflex bladder (incontinence) No neurogenic disturbances of function Changes in renal function No details known Global renal insufficiency - slight (50-80%) - moderate (25-50%) - severe (10-25%) On dialysis or = 100/HPF or ~t (Category L/6) WBC casts Erythrocyturia (as leukocyturia) No details 0 - 1/HPF or ~t (Category L/l) 2 - 4/HPF or lxl (Category L/2)

to

Japanese

6.2.3 6.2.4 6.2.5 6.2.6 6.3 6.3.0 6.3.1 6.3.2 6.3.3 6.3.4 6.3.9 6.4 6.4.0 6.4.1 6.4.2 6.4.9 6.5 6.5.0 6.5.1 6.5.2 6.5.3 6.5.9 6.6 6.6.0 6.6.t 6.6.2 6.6.3 6.6.4 6.6.5 6.6.9 6.7 6.7.0 6.7.1 6.7.9 6.8 6.8.0 6.8.1 6.8.2 6.8.9

5 - 9/HPF or ~1 (Category L/3) 10 - 49/HPF or ~I (Category L/4) 50 - 99/HPF or ~tl (Category L/5) > = 100/HPF or lxl (Category L/6) Parameters for diagnosis of sepsis No details or no data obtained Leukocytes Thrombocytes Coagulation parameters Other parameters No pathological changes for urosepsis Ultrasound No details known Upper urinary tract (kidneys) Lower urinary tract (bladder) No pathological ultrasound findings Radiological findings No details known Excretory and infusion urogram Cystourethrogram, also during voiding Urethrograrn No pathological radiotogicat findings Urodynamic investigation No details known Urine flow Cystometry Urethral pressure profile Electromyography (EMG) Other investigations (e.g. neurological) No pathological urodynamic findings Functional (e.g. nuclear medicine) investigations No details known Unilateral nephrogram No pathological findings Computer tomography (CT) or nuclear magnetic resonance (NMR) No details known CT NMR No pathological findings

VII. Site and Classification of UTI 7.0 7.1 7.1.0 7.1.1 7.1.2 7.1.3 7.1.4 7.1.5 7.1.9 7.2 7.2.0 7.2.1 7.2.2 7.2.3 7.2.4

(Indication of investigative methods under § 5) No data Urosepsis No details known Origin in upper urinary tract (primary) Origin in upper urinary tract after iatrogenic intervention Origin in lower urinary tract (primary) Origin in lower urinary tract after iatrogenic intervention Other Origin in urinary tract not localizable Pyelonephritis with fever (> 38°C) (with typical clinical symptoms) No details known With pathological changes in urinary tract With relevant concurrent conditions With no pathological changes in urinary tract Bilateral

Infection 20 (1992) Suppl. 3 © MMV Medizin Verlag GmbH Miinchen, Mtinchen 1992

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K. G. Naber: Characteristics of Patients with UTI 7.2.5 7.2.9 7.3

7.3.0 7.3.1 7.3.1.1" 7.3.1.2 7.3.2 7.3.3 7.3.3.1" 7.3.3.2 7.3.4*

Unilateral Not classifiable on basis of findings Complicated UTI (with pathological changes in the urinary tract but no signs and symptoms of pyetonephritis with fever) No details known After/on use of catheter, splint, etc. Duration of use and time of removal (see definition according to 5.1) Continuous urethral catheter Other catheter, stents etc. Following intervention in upper urinary tract Following intervention in lower urinary tract Following prostatic surgery (transurethral resection or open prostatectomy) Following other interventions in the lower urinary tract without previous urinary tract interventions With pathological changes in upper urinary tract (upper

UTI) 7.3.5* %3.6

With pathological changes in lower urinary tract (lower

LrrD

Complicating conditions removed before or during antibacterial therapy 7.3.6.1 Complete removal 7.3.6.2 Partial removal 7.3.9 Not classifiable on basis of findings 7.4 Uncomplicated lower UTI 7.4.0 No details known 7.4.1 Cystitis (with typical clinical symptoms) 7.4.2 Other uncomplicated lower UTI * Special form important for Japanese criteria

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Special Forms 7.5 7.5.0 7.5:1 7.5.2 7.5.3 7.5.4 7.5.5 7.5.6 7.6 7.7 7.7.0 7.7.1 7.7.2 7.7.3 7.7.4 7.7.9 7.8 7.8.0 7.8.1 7.8.2 7.9

Epididymitis

No details known Acute, unilateral Acute, bilateral Subacute, unilateral Subacute, bilateral Chronic, unilateral Chronic, bilateral Seminal vesiculitis Prostatitis

No details known Acute Chronic, bacterial Nonbacterial (Chlamydia, ureaplasma) Prostatic abscess Prostatodynia Urethritis

No details known Acute Subacute UTI not precisely definable on the basis of the investigative methods used

Comment: With regard to 7.1-7.4 and 7.5-7.8, patients may be allocated to the higher position in the sequence (lower number) if several possibilities exist.

Infection 20 (1992) Suppl. 3 © MMV Medizin Verlag GmbH Miinchen, Miinchen 1992

Characteristics of patients with urinary tract infections.

Session I K. G. N a b e r Characteristics of Patients with Urinary Tract Infections Since the various types of urinary tract infections (UTI) differ...
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