Complex urologic infections are a heterogeneous group of underlying conditions. These patients have upper urinary tract infections (UTIs) and structural or functional abnormalities that reduce the efficacy of antimicrobial therapy. They are at greater risk for treatment failure and morbidity, such as bacteremia and sepsis, perinephric abscess, renal deterioration and emphysematous pyelonephritis. While there are general management principles that can be applied to most patients with complex urologic infections, effective treatment requires a comprehensive, personalized approach to improve patient outcomes.
In pursuit of this goal, the Northwestern Medicine Complex Urologic Infectious Diseases Clinic is the first of its kind in the country. The clinic will provide a multidisciplinary, coordinated approach to care for affected patients. In this Better Edge podcast episode, the clinic’s founders – Anthony J. Schaeffer, MD, of the Northwestern Medicine Department of Urology, and Teresa R. Zembower, MD, and Janna L. Williams, MD, of the Northwestern Medicine Division of Infectious Diseases in the Department Medicine – introduce the new clinic and discuss their team’s current projects and future directions.
Introducing the First Complex Urologic Infectious Diseases Clinic in the U.S.
Featured Speakers:
Learn more about Anthony Schaeffer, MD
Anthony Schaeffer, MD | Janna Williams, MD | Teresa Zembower, MD
Anthony J. Schaeffer, MD, is the Herman L. Kretschmer Professor of Urology at Northwestern Medicine. Dr. Schaeffer participated in the committee that evaluated and revised the Infectious Diseases Society of America’s (IDSA) guidelines for the screening and treatment of asymptomatic bacteriuria (ASB), which are considered the standard for evidence-based treatment.Learn more about Anthony Schaeffer, MD
Janna L. Williams, MD, is an assistant professor of Medicine in the Division of Infectious Diseases at Northwestern Medicine
Learn more about Janna Williams, MD
Learn more about Janna Williams, MD
Teresa R. Zembower, MD, is a professor of Medicine in the Division of Infectious Diseases and a professor of Pathology at Northwestern Medicine.
Learn more about Teresa Zembower, MD
Learn more about Teresa Zembower, MD
Transcription:
Introducing the First Complex Urologic Infectious Diseases Clinic in the U.S.
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for Physicians. I'm Melanie Cole. And joining me in this thought leader round table today is Dr. Anthony Schaeffer. He's the Herman L crutch more professor of urology at Northwestern Medicine, Dr. Janna Williams. She's an assistant professor of medicine in the division of disease at Northwestern Medicine. And Dr. Teresa Zembower. She's a professor of medicine in the division of infectious disease and pathology at Northwestern Medicine. And they are here to highlight complex urologic infectious diseases. Thank you all for being with us today. And Dr. Shaeffer, I'd like to start with you. I'd like you to kind of give us just a brief overview of complex urologic infectious diseases. What are we talking about here today? What fits under this umbrella term?
Dr Anthony Schaeffer: Well, that's a great question. I think the way to think about it is that a urinary tract infection is interaction between a bacterial pathogen and a host. If the pathogen is particularly virulent or has a lot of resistance genes and or if the host has a compromised urinary tract that doesn't function properly and is unable to protect itself by emptying the urine from the system, then a patient with one or both of those scenarios would have a complex urinary tract infection and would be a prime candidate for this clinic.
Melanie Cole (Host): Thank you so much, Dr. Shaeffer for kind of giving us that brief overview. Now, Dr. Williams, I'd like you to tell us about the complex urologic infectious diseases clinic at Northwestern Medicine. What need are you filling? Tell us a little bit about how this came about and your objectives.
Dr Janna Williams: Hi, and thank you for having us. One of the reasons we wanted to do this is there had been a longstanding relationship between infectious disease and urology here at Northwestern with preexisting research collaboration, as well as a lot of shared, clinical experiences between the divisions. And what we saw is that there is a need for multidisciplinary care for these patients who oftentimes have more complex or difficult to treat conditions.
And having multiple providers from the different specialties in the same setting really helps to, foster collaboration and streamline care on a patient level. So that is one of the needs that we hope to meet as well as there are a lot of unanswered questions and the best way to diagnose, treat and long term management of these patients. So we hope to further elucidate pathways to help with overall care of patients with these conditions.
Melanie Cole (Host): Such an important topic and Dr. Zembower, how will this treatment model be different from what's already established in the market? How do things like advancements in instrumentation give birth to this era of robotic lap, endoscopic techniques and all these new imaging advancements. Tell us a little bit about how this will differentiate Northwestern Medicine?
Dr Teresa Zembower: Thank you, Melanie. I think that's really an important question. So as Dr. Williams has said, we've been working together with urology for a long time, but how this will be different is that to our knowledge, this will be the first of this type of clinic. Which is a combined comprehensive urologic infections clinic in one space where the patient patients can come for sort of a one stop shop to see infectious diseases and urology at the same time to formulate a treatment plan, implement the plan and follow the outcomes.
So if a patient, for instance needs, a comprehensive infection workup, but also needs a urologic procedure, then they can get that same plan, streamlined in one. And maybe I would ask Dr. Shaeffer to talk about the different, techniques or new technologies in urology and how that will be beneficial, within this clinic space.
Dr Anthony Schaeffer: Well, thank you, Teresa. I think many people know that most of our procedures are now being done in an outpatient setting. So even more complex urologic procedures can be done in that way, but the clinic itself will be able to, do the types of procedures that are needed to assess the status of the urinary tract. When we talk about a complex infection, we assume the patient has abnormalities, but the one of the roles of the urologist is to define precisely how the urinary tract is or is not working. And that could include imaging urodynamic studies through a determine function, endoscopic evaluation of the upper and lower urinary tract and all these things today can be done in a very comfortable way, in the outpatient setting.
Melanie Cole (Host): Well, Dr. Shaeffer, I'd like you to expand for just a minute on the type of patients. I'd like you to speak a little bit about patient selection, who this program is intended for, because that's very specific and important to note for referring physicians?
Dr Anthony Schaeffer: The simplest way for the referring physician to think about it is that, many urinary tract infections, particularly in women are uncomplicated. It can be dealt with, easily in the office with routine three day therapy of antibiotics. As we see elderly patients, men, in particular and women who don't respond to traditional approaches that I've outlined, then I think the clinician is going to whether or not they need to get further advice or help in managing a patient.
So the simplest way for the clinician to think about it is a patient who doesn't respond to what they believe to be standard of care therapy. The patient isn't getting over the infection, the patient is coming back for repeated infections. The bacteria are becoming more and more resistant. And at that point, I believe the referring physician or the clinician would say, I need to refer this patient to get a second opinion from this special clinic at Northwestern.
Melanie Cole (Host): Dr. Williams, I think one of the more important things, and then you guys have just touched on it just a little bit in how easy this is for patients that it's all in one spot. I'd like you to speak about the specialties. That are represented there and you all represent different specialties, but tell us why a multidisciplinary team is so important for these patients. What are you finding are the largest benefits?
Dr Janna Williams: Yeah. So that's a great question. I think a lot of our care today gets very siloed into sub subspecialties and, there's not as much crosstalk between specialties. Here, having both the infectious disease physicians, as well as, the urologists and all the subspecialties within urology, in the same room is that we can go over each patient case, which is gonna be unique and go through all the reasons for why we think they have a recurrent infection or more challenging to treat.
Going through the anatomy, any structural or functional abnormalities and how that plays into any recurrence for infection or how we would go about managing that infection differently. So it would foster collaboration in real time on the spot, and then hopefully streamline what workup that patient needs. So it makes sure we get the most effective study or most effective treatment for that patient.
Melanie Cole (Host): So now, Dr. Williams, how will research and clinical trials factor into this clinic? How have you seen research? You've done affect patient care and urology? Tell us about any research that other providers may not know about and how you envision this research translating to patient care?
Dr Janna Williams: Yeah. So I'd be happy to start with that question, but I think Dr. Zembower and Dr. Shaeffer have had a long standing research relationship, really starting with a lot of looking at appropriate and optimizing antimicrobial prophylaxis prior to urologic procedures. And that's still ongoing. And what we would like to do moving forward is to hopefully through this clinic, we'll be able to identify some of the nuances to diagnosis that makes complex urologic infections difficult, as well as gather information on the best way to standardize assessment and treatment, and then looking at long term outcomes.
So that way in the future, we will have optimized care protocols, that are both, personalized yet can also be replicated. across other patients, other centers where we hope we can, provide education to both our patients, our peers, and our referring providers. But I would like to open it up to Dr. Zembower and Dr. Shaeffer, for their thoughts on research initiatives in the future, HR.
Dr Teresa Zembower: I completely agree with Janna. While all the care will be personalized, there will be categories of patients. Patients, for instance, with, bladder infections versus recurrent kidney infections or prostate infections. And so what we plan to do is to learn from the personalized care that we provide, but also standardized care amongst the different diagnoses and study that and share our knowledge, that we're going to glean from this clinic, with our patients, our peers, and our referring providers. Tony, I don't know if you have anything else to add about the research component of this.
Dr Anthony Schaeffer: Yeah, I can give you a real time example, because of the Genesis of this clinic I have been approached. and I think we, as a group will be testing a new system that can I. using DNA techniques, what species are involved in a urinary tract infection? How many are there and what resistance genes, the pathogen possesses? And the exciting thing about this is that it can be done in 20 minutes. And as the audience knows a typical urinary culture takes 24 to 48 hours and sensitivity testing as well. So this is a situation where they've come to us and recognizing our, the combined expertise of the clinic, ask us to be a site to test a system that can do this.
And that's just one example of something that will be researched, but also obviously bear fruit immediately for patients in the clinic. I add one other thing. And I think our goal here is, not only to assess and make a treatment plan, but also to incorporate the expertise of the referring physician, as well as the patient in the long term management. So that's something I think that we have had a tradition of doing, and that literally means that we will form a team beyond the clinic with referring physicians, in patients who will help us manage the infection.
Melanie Cole (Host): What an exciting time to be in your field. I'd like to give you all a chance for a final thought. So, Dr. Zembower starting with you. Is there anything else you'd like providers to know about treating patients with complex urologic infections when referring patients to your clinic? When do you feel that that is important?
Dr Teresa Zembower: Yeah. I mean, I think we want to be very inclusive in this clinic. We want, all providers to feel welcome to refer their patients to this clinic. And we're gonna start seeing patients, our first clinic will be October 6th up in the urology area, that's where the clinic will be held. So we want providers to know that. They can have their patients call us, call the clinic to schedule, they can call or page us, or send us EPIC messages themselves to discuss specific patients.
And they can also order consults electronically through EPIC, through the urology referral. So we really want this to be very collaborative. As Dr. Shaeffer said, we want to be working with the patients and the providers. And we just want them to know that we're open to seeing any patient that they feel would benefit from our combined expertise.
Melanie Cole (Host): Dr. Williams, what would you like us to know about complex urologic disease and what you see coming down the pipeline or your hope, your goals for the clinic and any future advancements that you would like to see happen?
Dr Janna Williams: Yeah, I think this is a very exciting time to develop a clinic like this. Especially as there are shifts in the urologic procedures being done, how they're being performed, this setting that they're being performed, there might be newer, unique challenges and an optimal time that we're able to hone in and enhance our care delivery. Part of it will be infection prevention. How can we prevent infections from happening? But as we know that patients undergo more complex procedures have more complex anatomy, we're gonna need to meet their needs as well. And I think this clinic is gonna be uniquely suited to do so.
Melanie Cole (Host): Thank you for that. And Dr. Shaeffer, last word to you. What would you like the key takeaway from this podcast today? You've all been here together telling us about exciting advancements in complex urologic infectious diseases. What would you like the main messages to be?
Dr Anthony Schaeffer: I think this is a patient centric clinic. the patients themselves present with symptoms. And are we obviously talking about bacterial infections? It's fair to say that some patients' symptoms may be related to something else. It could be interstitial cystitis or a, other type of problem. So this clinic is really holistic, and we're thinking about the patient and their symptoms and the role of infection and other factors that may contribute to it.
Melanie Cole (Host): Thank you all so much for joining us today, telling us about the clinic and sharing your incredible expertise. And to refer your patient, or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for Physicians. I'm Melanie Cole.
Introducing the First Complex Urologic Infectious Diseases Clinic in the U.S.
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for Physicians. I'm Melanie Cole. And joining me in this thought leader round table today is Dr. Anthony Schaeffer. He's the Herman L crutch more professor of urology at Northwestern Medicine, Dr. Janna Williams. She's an assistant professor of medicine in the division of disease at Northwestern Medicine. And Dr. Teresa Zembower. She's a professor of medicine in the division of infectious disease and pathology at Northwestern Medicine. And they are here to highlight complex urologic infectious diseases. Thank you all for being with us today. And Dr. Shaeffer, I'd like to start with you. I'd like you to kind of give us just a brief overview of complex urologic infectious diseases. What are we talking about here today? What fits under this umbrella term?
Dr Anthony Schaeffer: Well, that's a great question. I think the way to think about it is that a urinary tract infection is interaction between a bacterial pathogen and a host. If the pathogen is particularly virulent or has a lot of resistance genes and or if the host has a compromised urinary tract that doesn't function properly and is unable to protect itself by emptying the urine from the system, then a patient with one or both of those scenarios would have a complex urinary tract infection and would be a prime candidate for this clinic.
Melanie Cole (Host): Thank you so much, Dr. Shaeffer for kind of giving us that brief overview. Now, Dr. Williams, I'd like you to tell us about the complex urologic infectious diseases clinic at Northwestern Medicine. What need are you filling? Tell us a little bit about how this came about and your objectives.
Dr Janna Williams: Hi, and thank you for having us. One of the reasons we wanted to do this is there had been a longstanding relationship between infectious disease and urology here at Northwestern with preexisting research collaboration, as well as a lot of shared, clinical experiences between the divisions. And what we saw is that there is a need for multidisciplinary care for these patients who oftentimes have more complex or difficult to treat conditions.
And having multiple providers from the different specialties in the same setting really helps to, foster collaboration and streamline care on a patient level. So that is one of the needs that we hope to meet as well as there are a lot of unanswered questions and the best way to diagnose, treat and long term management of these patients. So we hope to further elucidate pathways to help with overall care of patients with these conditions.
Melanie Cole (Host): Such an important topic and Dr. Zembower, how will this treatment model be different from what's already established in the market? How do things like advancements in instrumentation give birth to this era of robotic lap, endoscopic techniques and all these new imaging advancements. Tell us a little bit about how this will differentiate Northwestern Medicine?
Dr Teresa Zembower: Thank you, Melanie. I think that's really an important question. So as Dr. Williams has said, we've been working together with urology for a long time, but how this will be different is that to our knowledge, this will be the first of this type of clinic. Which is a combined comprehensive urologic infections clinic in one space where the patient patients can come for sort of a one stop shop to see infectious diseases and urology at the same time to formulate a treatment plan, implement the plan and follow the outcomes.
So if a patient, for instance needs, a comprehensive infection workup, but also needs a urologic procedure, then they can get that same plan, streamlined in one. And maybe I would ask Dr. Shaeffer to talk about the different, techniques or new technologies in urology and how that will be beneficial, within this clinic space.
Dr Anthony Schaeffer: Well, thank you, Teresa. I think many people know that most of our procedures are now being done in an outpatient setting. So even more complex urologic procedures can be done in that way, but the clinic itself will be able to, do the types of procedures that are needed to assess the status of the urinary tract. When we talk about a complex infection, we assume the patient has abnormalities, but the one of the roles of the urologist is to define precisely how the urinary tract is or is not working. And that could include imaging urodynamic studies through a determine function, endoscopic evaluation of the upper and lower urinary tract and all these things today can be done in a very comfortable way, in the outpatient setting.
Melanie Cole (Host): Well, Dr. Shaeffer, I'd like you to expand for just a minute on the type of patients. I'd like you to speak a little bit about patient selection, who this program is intended for, because that's very specific and important to note for referring physicians?
Dr Anthony Schaeffer: The simplest way for the referring physician to think about it is that, many urinary tract infections, particularly in women are uncomplicated. It can be dealt with, easily in the office with routine three day therapy of antibiotics. As we see elderly patients, men, in particular and women who don't respond to traditional approaches that I've outlined, then I think the clinician is going to whether or not they need to get further advice or help in managing a patient.
So the simplest way for the clinician to think about it is a patient who doesn't respond to what they believe to be standard of care therapy. The patient isn't getting over the infection, the patient is coming back for repeated infections. The bacteria are becoming more and more resistant. And at that point, I believe the referring physician or the clinician would say, I need to refer this patient to get a second opinion from this special clinic at Northwestern.
Melanie Cole (Host): Dr. Williams, I think one of the more important things, and then you guys have just touched on it just a little bit in how easy this is for patients that it's all in one spot. I'd like you to speak about the specialties. That are represented there and you all represent different specialties, but tell us why a multidisciplinary team is so important for these patients. What are you finding are the largest benefits?
Dr Janna Williams: Yeah. So that's a great question. I think a lot of our care today gets very siloed into sub subspecialties and, there's not as much crosstalk between specialties. Here, having both the infectious disease physicians, as well as, the urologists and all the subspecialties within urology, in the same room is that we can go over each patient case, which is gonna be unique and go through all the reasons for why we think they have a recurrent infection or more challenging to treat.
Going through the anatomy, any structural or functional abnormalities and how that plays into any recurrence for infection or how we would go about managing that infection differently. So it would foster collaboration in real time on the spot, and then hopefully streamline what workup that patient needs. So it makes sure we get the most effective study or most effective treatment for that patient.
Melanie Cole (Host): So now, Dr. Williams, how will research and clinical trials factor into this clinic? How have you seen research? You've done affect patient care and urology? Tell us about any research that other providers may not know about and how you envision this research translating to patient care?
Dr Janna Williams: Yeah. So I'd be happy to start with that question, but I think Dr. Zembower and Dr. Shaeffer have had a long standing research relationship, really starting with a lot of looking at appropriate and optimizing antimicrobial prophylaxis prior to urologic procedures. And that's still ongoing. And what we would like to do moving forward is to hopefully through this clinic, we'll be able to identify some of the nuances to diagnosis that makes complex urologic infections difficult, as well as gather information on the best way to standardize assessment and treatment, and then looking at long term outcomes.
So that way in the future, we will have optimized care protocols, that are both, personalized yet can also be replicated. across other patients, other centers where we hope we can, provide education to both our patients, our peers, and our referring providers. But I would like to open it up to Dr. Zembower and Dr. Shaeffer, for their thoughts on research initiatives in the future, HR.
Dr Teresa Zembower: I completely agree with Janna. While all the care will be personalized, there will be categories of patients. Patients, for instance, with, bladder infections versus recurrent kidney infections or prostate infections. And so what we plan to do is to learn from the personalized care that we provide, but also standardized care amongst the different diagnoses and study that and share our knowledge, that we're going to glean from this clinic, with our patients, our peers, and our referring providers. Tony, I don't know if you have anything else to add about the research component of this.
Dr Anthony Schaeffer: Yeah, I can give you a real time example, because of the Genesis of this clinic I have been approached. and I think we, as a group will be testing a new system that can I. using DNA techniques, what species are involved in a urinary tract infection? How many are there and what resistance genes, the pathogen possesses? And the exciting thing about this is that it can be done in 20 minutes. And as the audience knows a typical urinary culture takes 24 to 48 hours and sensitivity testing as well. So this is a situation where they've come to us and recognizing our, the combined expertise of the clinic, ask us to be a site to test a system that can do this.
And that's just one example of something that will be researched, but also obviously bear fruit immediately for patients in the clinic. I add one other thing. And I think our goal here is, not only to assess and make a treatment plan, but also to incorporate the expertise of the referring physician, as well as the patient in the long term management. So that's something I think that we have had a tradition of doing, and that literally means that we will form a team beyond the clinic with referring physicians, in patients who will help us manage the infection.
Melanie Cole (Host): What an exciting time to be in your field. I'd like to give you all a chance for a final thought. So, Dr. Zembower starting with you. Is there anything else you'd like providers to know about treating patients with complex urologic infections when referring patients to your clinic? When do you feel that that is important?
Dr Teresa Zembower: Yeah. I mean, I think we want to be very inclusive in this clinic. We want, all providers to feel welcome to refer their patients to this clinic. And we're gonna start seeing patients, our first clinic will be October 6th up in the urology area, that's where the clinic will be held. So we want providers to know that. They can have their patients call us, call the clinic to schedule, they can call or page us, or send us EPIC messages themselves to discuss specific patients.
And they can also order consults electronically through EPIC, through the urology referral. So we really want this to be very collaborative. As Dr. Shaeffer said, we want to be working with the patients and the providers. And we just want them to know that we're open to seeing any patient that they feel would benefit from our combined expertise.
Melanie Cole (Host): Dr. Williams, what would you like us to know about complex urologic disease and what you see coming down the pipeline or your hope, your goals for the clinic and any future advancements that you would like to see happen?
Dr Janna Williams: Yeah, I think this is a very exciting time to develop a clinic like this. Especially as there are shifts in the urologic procedures being done, how they're being performed, this setting that they're being performed, there might be newer, unique challenges and an optimal time that we're able to hone in and enhance our care delivery. Part of it will be infection prevention. How can we prevent infections from happening? But as we know that patients undergo more complex procedures have more complex anatomy, we're gonna need to meet their needs as well. And I think this clinic is gonna be uniquely suited to do so.
Melanie Cole (Host): Thank you for that. And Dr. Shaeffer, last word to you. What would you like the key takeaway from this podcast today? You've all been here together telling us about exciting advancements in complex urologic infectious diseases. What would you like the main messages to be?
Dr Anthony Schaeffer: I think this is a patient centric clinic. the patients themselves present with symptoms. And are we obviously talking about bacterial infections? It's fair to say that some patients' symptoms may be related to something else. It could be interstitial cystitis or a, other type of problem. So this clinic is really holistic, and we're thinking about the patient and their symptoms and the role of infection and other factors that may contribute to it.
Melanie Cole (Host): Thank you all so much for joining us today, telling us about the clinic and sharing your incredible expertise. And to refer your patient, or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for Physicians. I'm Melanie Cole.