Generalized Symptoms In Adult Women With Acute Uncomplicated Lower Urinary Tract Infection: An Observational Study

Anders Baerheim, MD, PhD, Asbjørn Digranes, MD, Roland Jureen, MD, Kirsti Malterud, MD, PhD

Disclosures
In This Article

Materials and Methods

A total of 469 women, 18 years or older, consulting for acute dysuria and/or urinary frequency were consecutively evaluated for inclusion during 10 months from August 1999. Eight general practices dispersed over southern Norway participated.

Of the 469 women, 71 were excluded because of complicating factors as judged by their doctor (diabetes [11], catheter [4], pregnancy [7], fever [26], or other [23]) and 6 because the data set was incomplete for central variables.

At inclusion, patients filled in a detailed questionnaire on acute symptoms. Symptoms necessary for inclusion were acute dysuria or urinary frequency. A lower UTI was defined as the presence of acute dysuria and/or urinary frequency (Figure 1).[1,2] Bacteriuria was defined as 105 or more colony-forming units/mL, or any amount of Staphylococcus saprophyticus. Uropathogens were defined as Escherichia coli and other Gram-negative intestinal rods, S saprophyticus, and enterococci.

A practical classification of urinary tract infection for management in general practice/family medicine.

Patients produced a urine sample at the surgery after careful instruction in the clean-catch midstream technique. A dip-slide was inoculated with the urine within half an hour and sent to the Department of Microbiology and Immunology, Haukeland University Hospital, where it was analyzed using standard techniques.

The symptom list in the questionnaire was based on findings from our qualitative study.[7] A total of 13 possible symptoms, 6 generalized, 4 voiding related, and 3 constant local symptoms were included ( Table 1 ). Subjects were asked to score symptoms they experienced as related to their present cystitis, according to how they felt the same day. Scores were given on a 5-step categorical scale ranging from 1 = "not present" to 5 = "very much present" for each symptom.

The study was approved by the Regional Committee for Medical Research Ethics and the Norwegian Data Directorate.

Symptom scores are presented dichotomized as absent (score = 1) or present (scores ≥ 2). Full score ranges were used for Factor analysis. Main results are given as proportions and means with 95% confidence intervals. Differences in proportions between groups were tested with Chi-square tests.

Symptom clusters were identified using Factor analysis.[8] The KMO Test, Anti-image covariance, and Measures of Sampling Adequacy were performed, and indicated that the material was suited for Factor analysis. Components were included for eigenvalues ≥ 1. Differences between the components were tested with one-way ANOVA test or t-test.

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