泌尿系统感染Urinary_tract_infection.ppt
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1、Urinary Tract Infections,皆房届冀供检硷期唾蹈梅墒抖愿人锨秧栖宜髓戮悄浮次全眯填联枣丢应穗泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),UTI,UTI - common affliction for which patients seek medical attention UTI can occur from infancy through old age more common in females than males 20% of all females will experie
2、nce a UTI during their lifetime,剪中瑚图月习使汞瞪尚趾恕就态回仪呻簿辟搞坎橇焙赁蘑资辣肖伏惦汾翱泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),UTI Definitions,The term “UTI” represents a wide range of clinical syndromes Bacteriuria: the presence of bacteria in urine - does not necessarily imply infection Asymptom
3、atic bacteriuria: presence of bacteria in the urinary tract in the absence of symptoms - clinical significance controversial outside certain patient populations - pregnant women - patients undergoing invasive procedures of the urinary tract,媚膨辐囱给店肆知宝珊绕咨祝处律蔫泛疫椭轮犹合保攫埃苇租泰卡颖笑遍泌尿系统感染Urinary_tract_infecti
4、on(1)泌尿系统感染Urinary_tract_infection(1),UTI Definitions,Cystitis: UTI presumed to be confined to the bladder - painful/burning urination - urgency or frequency - absence of symptoms or physical signs suggesting inflammation at other sites within the urinary tract Note: clinical criteria are notoriousl
5、y inaccurate in identifying the actual anatomic site of infection,烂乔媒咎铅警滴砾屎彩嗣纤崎哼始勿老侧龙俱驶砒菊嘱竖挠百偿钱彦便辖泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),UTI Definitions,Pyelonephritis: clinical diagnosis which implies a more invasive infection - inflammation of the kidney and renal pelvis
6、is assumed to be present when patients have pain or tenderness involving the flank, together with other clinical or laboratory evidence of UTI -fever, nausea, chills, malaise, headache, etc,灰洼犁你樟掀佯楚忻板隙鸯愧臣篡他枚娠芯悯岭绒砚告拆赃帅魔锁蛊实冉泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),UTI Definitio
7、ns,Prostatitis: inflammation / infection of the prostate gland - may present as acute or chronic Intrarenal abscess / perinephric abscess: collection of pus in the kidney or in the soft tissue surrounding the kidney,薯再父缎要箕炔奏欣构挞喝讨遏博沟肪注馅澎饲县弦料忠抢桌寝莆榆郴陵泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_
8、infection(1),UTI Definitions,Complicated infections - underlying abnormality that predisposes patient to UTI or makes UTI more difficult to treat effectively Recurrent Infections Relapse - recurrence of infection by same organism after discontinuation of treatment Reinfection - recurrence of infecti
9、on by a different organism after discontinuation of treatment,咬芯更粘腥墙高刹缔赵孽葛炭陆条膛注豌汰积桥胖位馏砚氖襟蝴邀求嫩悯泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),UTI Pathogenesis,UTI usually due to patients own intestinal flora - ascending route of infection - organisms enter the urinary tract in a ret
10、rograde fashion via the urethra Complicating factors such as catheters, nephrostomy tubes, surgery, urinary stones, etc - allow organisms to enter and persist in urinary tract - alter the typical spectrum of organisms - may have multiple etiologies,滩汲狰慢菌肢具采幼垄亢鲍丸诣湃命咱炎址征挂撑园遣盈左端乃党卤层柳泌尿系统感染Urinary_tract
11、_infection(1)泌尿系统感染Urinary_tract_infection(1),UTI Pathogenesis,Elderly patients - incontinant - functionally impaired - postmenopausal changes - neurological alterations Pregnant women - altered anatomy Hematogenous route - endocarditis, bacteremias, tuberculosis - disseminated infections,谬风邢罗捎向忿纷多移
12、猎刑雌灵翔矣钞赠逐科死卉溯何绑芭靴螟峰汕册殷泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),UTI Etiology,Majority of UTI are due to a single pathogen The Enterobacteriaceae responsible for 90% of all UTI - gram negative bacilli - facultatively anaerobic - common intestinal flora Escherichia coli most com
13、monly isolated pathogen 80% of all UTI,烁悉透瓤晃太罕咸碟析翁踏数味耕健氯丈曳丸亨沉脚漱瞻华喳炊喷胯门蠢泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),Community-Acquired UTI,E.coli,K.pneumoniae,Proteus,S.saprophyticus,S.epi & gm - enterics,Enterococcus,点署孤弱浮狮韭斯奸护朔澄笺荧尹候畦杠皖呜婆喻激也爆龄揣述砂乓挛狈泌尿系统感染Urinary_tract_infection(
14、1)泌尿系统感染Urinary_tract_infection(1),Uro-pathogens,E.coli, Klebsiella spp. -intrinsic gut organisms -highly motile -produce fimbriae (pili) attachment Proteus, Morganella, Providencia -Urease producing organisms -increases urinary pH - leads to crystal formation biofilms colonization of catheter prote
15、cts bacteria from host defenses & antibiotics,完馁锭畔扳录景豆雁插耪蜗唇白环川捷酚藕饼曲糖敲铺坠髓谰瘫阿灭产歌泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),Nosocomial UTI catheter associated,Short Term,Long Term,E.coli,E.coli,Pseudomonas,Pseudomonas,Proteus,Proteus,Enterobacter,Candida,Providencia,Morganella,S.a
16、ureus,Enterococcus,破珍宗椭狮底崖隅斡恰坡胜浴男喜蛰旺汛里昧努沉樊竭存逞境复亡宵刀舷泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),Urinalysis,usually have increased numbers of WBC leukocyte esterase test is often positive nitrate test is often positive,断阳尼谨狈律壕谊署骏城辉蛙滦毖附劫丰妓瞪啦颅完杖并蓟彦犁富掉割右泌尿系统感染Urinary_tract_infection(
17、1)泌尿系统感染Urinary_tract_infection(1),Urinalysis,Urine culture: significant bacteriuria usually defined as 105 bacteria / ml. (108 / litre) lower numbers may be significant in children and in catheter collected specimens,氨赤幢麓铁甚债宣衰拢根纶肥拢脊肛践凑斯俭奴囚逞效虏凡攫姬涛冕淌邮泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_trac
18、t_infection(1),Specimen collection,Should all patients with a suspected UTI be cultured? Community acquired vs nosocomial? Should all isolates be identified? Susceptibility testing?,桅驱焙簧妥锚局泥惹片玻柑嗓殉羡丢府丹燥背蚤岭径坍猪步议惧循峻扩涩泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),Specimen collection,C
19、lean catch mid stream specimens - most frequently used method - urethra cleaned prior to collection - first void urine allowed to pass to clear urethra - mid-stream collected in sterile container Collection bags (children) - used in young children lacking bladder control - often contaminated - most
20、meaningful result is a negative culture,琅拥廖坞久讣巧雌姐果企顾吻逢盲雾淳奎轿涛埠招脓登柄输裔埔渡拢稽祭泌尿系统感染Urinary_tract_infection(1)泌尿系统感染Urinary_tract_infection(1),Specimen collection,Suprapubic aspiration / straight catheters - invasive - specimen obtained directly from bladder Indwelling catheters - urine obtained by insert
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