Urinary tract infections clinical presentation

Clinical Presentation of Urinary Tract Infections (UTIs) in Adults... 

A 59-year-old woman presents to an urgent care clinic with a 4-day history of frequent and painful urination. She has had fevers, chills, and flank pain for the last 2 days. Her physician advised her to immediately come to the clinic for evaluation. In the clinic she is febrile (38.5°C [101.3°F]) but otherwise stable and states she is not experiencing any nausea or vomiting. Her urine dipstick test is positive for leukocyte esterase. Urinalysis and urine culture are also ordered. Her past medical history is significant for three urinary tract infections in the past year. Each of these episodes was uncomplicated, treated with trimethoprim-sulfamethoxazole, and promptly resolved. She also has osteoporosis for which she takes a daily calcium supplement. The decision is made to treat her with oral antibiotics for a complicated urinary tract infection with close follow-up. Given her history what would be a reasonable empiric antibiotic choice Depending on the antibiotic choice are there potential drug interactions she should be counseled on ... 

The philosophy of evidence-based practice is widely accepted, although operational and implementation issues represent major barriers. One of the significant barriers is a shortage of evidence reports on topics of critical interest, and the lack of a national infrastructure to prepare such reports. In response to this need, AHRQ has funded 12 Evidence-based Practice Centers to conduct systematic, comprehensive analyses and syntheses of the scientific literature to develop evidence reports and technology assessments on clinical topics that are common, expensive, and present challenges to decision makers. Since December 1998, 11 evidence reports have been released on topics that include sleep apnea, traumatic brain injury, alcohol dependence, cervical cytology, urinary tract infection, depression, dysphasia, sinusitis, stable angina, testosterone suppression, and attention deficit hyperactivity disorder. 

The clinical presentation of MS is extremely variable among patients and typically varies over time in a given patient (Table 53-1). The signs and symptoms of MS usually are divided into three categories. Primary symptoms are a direct consequence of conduction disturbances produced by demyelination and axonal damage and reflect the area of the brain or spinal cord that is damaged. Secondary symptoms are complications resulting from primary symptoms. For example, urinary retention, a primary symptom, may lead to frequent urinary tract infections, considered a secondary symptom. Tertiary symptoms relate to the effect of the disease on the patient s everyday hfe. ... 

Johnson CC. Definitions, classification, and clinical presentation of urinary tract infections. Med Clin North Am 1991 75 241-252. 

A 50-year-old Hispanic female presents to your clinic with complaints of excessive thirst, fluid intake, and urination. She denies any urinary tract infection symptoms. She reports no medical problems, but has not seen a doctor in many years. On examination she is an obese female in no acute distress. Her physical exam is otherwise normal. The urinalysis revealed large glucose, and a serum random blood sugar level was 320 mg/dL. 

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