泌尿生殖道感染

泌尿生殖道感染泌尿生殖道感染第1頁

Urinarytractinfections(UTIs)causedbypathogenicbacteria

caninvolveanyofthegenitalorurinaryorgansandeventually

canspreadfromonesitetoany

oralloftheothers.

泌尿生殖道感染第2頁Definitions1

Urinarytractinfectionisaninflammatoryresponseoftheurotheliumtobacterialinvasionthatisusuallyassociatedwithbacteriuriaandpyuria.泌尿生殖道感染第3頁MostUTIsarecausedbyaerobicgram-negativerods,(Escherichiacoli.),gram-positivecocci(enterococci)andtoalesserextentbyanaerobicbacteria.

Definitions2

泌尿生殖道感染第4頁Definitions3Bacteriuriaisthepresenceofbacteriaintheurine,whichisnormallyfreeofbacteria,andimpliesthatthesebacteriaarefromtheurinarytractandarenotcontaminantsfromtheskin,vagina,orprepuce.泌尿生殖道感染第5頁Definitions4Pyuria

isthepresenceofwhiteblood

cellsintheurineBacteriuriawithoutpyuriaindicates

bacterialcolonizationratherthan

infection.Pyuriawithoutbacteriuriawarrants

evaluationfortuberculosis,stone,orcancer.泌尿生殖道感染第6頁Classification泌尿生殖道感染第7頁Accordingtotheirnaturehistory

Firstinfections/IsolatedInfection

Recurrentinfections

Bacterialpersistence

Reinfections

泌尿生殖道感染第8頁Reinfection

isrecurrentinfectionwithdifferentbacteriafromoutsidetheurinarytract.Eachinfectionisanewevent;theurinemustshownogrowth

aftertheprecedinginfection.泌尿生殖道感染第9頁Bacterial

persistencereferstoarecurrenturinarytractinfectioncausedbythesamebacteriafromafocuswithintheurinarytract,suchasaninfectionstoneortheprostate.泌尿生殖道感染第10頁

AccordingtoTheirSiteofOrigin

Upperurinarytractinfection

Lowerurinarytractinfection

Genitalsysteminfection

泌尿生殖道感染第11頁泌尿生殖道感染第12頁Upper-tractinfectionAcutepyelonephritisChronicpyelonephritisEmphysematouspyelonephritisRenalabscessPerinephricabscessXanthogranulomatouspyelonephritis泌尿生殖道感染第13頁 Lower-tractinfectionAcuteurethralsyndrome(Women)Acutecystitis泌尿生殖道感染第14頁

GenitalinfectionAcuteandchronicbacterialprostatitis.Acuteandchronicepididymitis.泌尿生殖道感染第15頁P(yáng)athogenesisBacterialpathogenesisintheurinarytractdependsonanumberoffacters,chiefofwhicharetheBacterial

VirulenceFactersandtheHostSusceptibilityFactor泌尿生殖道感染第16頁

Bacterialvirulencefactors

AbilityofadherencetourothelialcellsAbilitytoresistbactericidalactivityAbilitytoproducehemolysin.泌尿生殖道感染第17頁

HostsusceptibilityfactorsEmptyingofurineSurfacemucinsUrinaryantibodiesUrinaryosmolalitypH泌尿生殖道感染第18頁Routesofinfection(1)Ascendinginfection(2)Hematogenousspread(3)Lymphatogenousspread(4)Directextension

泌尿生殖道感染第19頁泌尿生殖道感染第20頁泌尿生殖道感染第21頁泌尿生殖道感染第22頁DIAGNOSIS泌尿生殖道感染第23頁UrineCollectionSuprapubicAspirationUrethralCatheterizationSegmentVoidedUrineSpecimens泌尿生殖道感染第24頁泌尿生殖道感染第25頁Urinlysis

Morethan3freshleukocytes/High-powerfield泌尿生殖道感染第26頁Quantitativeurineculture

Coloniesformingunitspermilliliter(cfu/ml)100,000cfu/ml1000to10,000cfu/ml泌尿生殖道感染第27頁Locationofurinarytractnfection.SymptomsandsignsLaboratoryfindingsX-RayfindingsRadionuclideimagingMRIfindings泌尿生殖道感染第28頁Treatmentstrategy.Antimicrobialdrug

Mdicationforpain,fever,andnausea.

Togivefluidsintravenouslyandorally

Complicatingfactors(eg.Obstructiveurographyorinfectedstones)泌尿生殖道感染第29頁

AcutePyelonephritis泌尿生殖道感染第30頁DefinitionsAcutepyelonephritisisdefinedasinflammationoftheparenchymaandthepelvisofthekidneycausingbybacterialinfection.泌尿生殖道感染第31頁Etiology&PathogenesisAerobicgram-negativebacteriaEcoli

Gram-negativeentricorganisms

Enterococci,andstaphylococcusaureusAscendinginfection(VUR)Hematogenous泌尿生殖道感染第32頁Clinicalfindings1Anabruptonsetofchill,moderatetohighfeverDysuria,frenquency,urgency.Abdominalpain,nausea,vomiting,andevendiarrhea.

泌尿生殖道感染第33頁Clinicalfindings2CostovertebralangletendernessPalpationorpercussionoverthecostovertebralangleontheaffectedkidneyusuallycausespain.Thepatientsometimeshasabdominaldistention,tenderness,andaquietintestine泌尿生殖道感染第34頁Dignosis1Laboratoryfindings:LeukocytosisPyuria,Bacteriuria,Proteinuria,HematuriaQuantitativeurinecultureTotalrenalfunction泌尿生殖道感染第35頁

Dignosis2

Imaging:PlainfilmExcretoryurograms.VoidingcystogramCTUltrasonographyRadionuclide泌尿生殖道感染第36頁DifferentialDiagnosisPancreatitisBasalpneumoniaAcute-intra-abdominaldiseaseWomenpelvicinflammatorydiseaseandacuteprostatitisRenalabscessPerinephricabcess.泌尿生殖道感染第37頁

Treatment1Antimicrobialdrugs:TheappropriateintravenoustreatmentOraldrugRepeaturinecultures泌尿生殖道感染第38頁

Treatment2Specificmeasures:Anycomplicatingfactors(eg.obstructiveurography)泌尿生殖道感染第39頁

Prostatitis泌尿生殖道感染第40頁TypesofprotatitisDrach(1978)(1)acuteandchronicbacterialprostatitis,(2)nonbacterialprostatitis(3)prostatodynia.泌尿生殖道感染第41頁NIDDKcategorizationandDrachclassificationNIDDKClassification(1995)Drachclassification(1978)Category1AcutebacterialprostatitisAcutebacterialprostatitisCategory2ChronicbacterialprostatitisChronicbacterialprostatitisCategory3Chronicpelvicpainsyndrom3aInflammatorytypeNonbacterialprostatitis

3bNoninflammatorytype

ProstatodyniaCategory4Asymptomaticinflammatoryprostatitis泌尿生殖道感染第42頁DiagnostictechniquesTheexpressedprostaticsecretions(EPS)Leukocytes<10perhigh-powerfield(hpf)

泌尿生殖道感染第43頁泌尿生殖道感染第44頁泌尿生殖道感染第45頁泌尿生殖道感染第46頁The4-glasstest(Stamey1968)UrethritisCystitisprostatitisVB1++/--/+VB2-+-EPS--/++(10timesthanVB1)VB3--/++泌尿生殖道感染第47頁泌尿生殖道感染第48頁泌尿生殖道感染第49頁Acutebacterialprostatitis泌尿生殖道感染第50頁Etiology&Pathogenesis

Ecoli80%

Enterococci5-10%AnaerobesrarelyIntraprostaticrefluxofurineInvasionbyrectalbacteriaHematogenousspread

泌尿生殖道感染第51頁Clinicalfeatures

Thesuddenonsetoffever,chills.Lowbackandperinealpain.Frenquencyandurgency,nocturia,dysuriaVaryingdegreesofbladderoutletobstruction.泌尿生殖道感染第52頁Digitalrectalexamination(DRE)Tender,swollenprostategland,irregularlyfirmandwarmUrinemaybecloudyandmalodorous,andgrosshematuriaisobserved泌尿生殖道感染第53頁Diagnosis

Acompletebloodcountshowsleukocytosiswithashifttowardimmatureforms.Thevoidedurineshowspyuria,microscopichematuria,andbacteria.CultureofvoidedurinesampleusuallyidentifiesthepathogensUltrasonography泌尿生殖道感染第54頁TreatmentAntibiotictreatmentfor4-6weeksSupportivemeasuresincludeantipyretics,analgesics,stoolsorfteners,hydration,andbedrest.Anytransurethralcatheterizationorinstrumentationiscontraindicated.Acuteurinaryretentionshouldbemanagedwithsuprapubicdrainage

泌尿生殖道感染第55頁Chronicbacterialprostatitis泌尿生殖道感染第56頁Etiology&PathogenesisThegram-nagativeorganismsThegram-positiveorganismsMycoplasmal,chlamydialspeciesIntraprostaticrefluxofurinepHofprostaticsecretionsZinc泌尿生殖道感染第57頁Clinicalfindings1Irritativevoidingdysfunction(dysuriaurgency,frequency,nocturia)LowbackorperinealpainSexualdysfunctionMyalgiaandarthralgiaOthersymptoms泌尿生殖道感染第58頁Clinicalfindings2DRE:normal,tenderness,swelling,firmnessSecondaryepididymitisHematouria,hematospermia,urethraldischarge泌尿生殖道感染第59頁DiagnosisThe4-glasstestTheexpressedprostaticsecretions(EPS)Leukocytes<10perhigh-powerfield(hpf)Sonography泌尿生殖道感染第60頁判別診療II型和III型應(yīng)與可能造成骨盆區(qū)域疼痛和排尿異常疾病進(jìn)行判別診療間質(zhì)性膀胱炎、睪丸附睪和精索疾病、肛門直腸疾病、腰椎疾病BPH、膀胱過分活動(dòng)癥、神經(jīng)原性膀胱膀胱腫瘤、前列腺癌泌尿生殖道感染第61頁治療標(biāo)準(zhǔn)慢性前列腺炎無明確進(jìn)展性，不足以威脅患者生命和主要器官功效，并非全部前列腺炎均需治療。慢性前列腺炎治療目標(biāo)主要是緩解疼痛、改進(jìn)排尿癥狀和提升生活質(zhì)量，療效評(píng)價(jià)應(yīng)以癥狀改進(jìn)為主。前列腺炎應(yīng)采取綜合治療。泌尿生殖道感染第62頁治療方法

一、Ⅰ型一旦臨床診療或得到血、尿培養(yǎng)結(jié)果后，應(yīng)馬上應(yīng)用抗生素。開始時(shí)可經(jīng)靜脈應(yīng)用抗生素，如：廣譜青霉素、三代頭孢菌素、氨基糖甙類或氟喹諾酮等。待患者發(fā)燒等癥狀改進(jìn)后，改用口服藥品（如氟喹諾酮等），療程最少4周。并發(fā)癥處理：伴尿潴留者——細(xì)管導(dǎo)尿或膀胱穿刺造瘺。伴膿腫形成者——可采取穿刺引流、經(jīng)尿道切開引流泌尿生殖道感染第63頁治療方法二、Ⅱ型和Ⅲ型（一）普通治療：

健康教育、心理和行為輔導(dǎo)有主動(dòng)作用。慢性前列腺炎患者應(yīng)戒酒，忌辛辣刺激食物；防止憋尿、久坐，注意保暖，加強(qiáng)體育鍛煉。熱水坐浴有利于緩解疼痛癥狀。泌尿生殖道感染第64頁治療方法

二、Ⅱ型和Ⅲ型（二）藥品治療

1．抗生素

2．α-受體阻滯劑

3．非甾體抗炎鎮(zhèn)痛藥

4．植物制劑

5．M-受體阻滯劑

6．抗抑郁藥及抗焦慮藥

7．中醫(yī)中藥泌尿生殖道感染第65頁治療方法

抗生素

Ⅱ型：依據(jù)細(xì)菌培養(yǎng)結(jié)果和藥品穿透前列腺能力選擇抗生素。藥品穿透前列腺能力取決于其離子化程度、脂溶性、蛋白結(jié)合率、相對(duì)分子質(zhì)量及分子結(jié)構(gòu)等。常見抗生素是氟喹諾酮類藥品（如環(huán)丙沙星、左氧氟沙星和洛美沙星等）、四環(huán)素類（如米諾環(huán)素等）和磺胺類（如復(fù)方新諾明）。前列腺炎確診后，抗生素治療療程為4~6周，泌尿生殖道感染第66頁治療方法

ⅢA型：抗生素治療大多為經(jīng)驗(yàn)性治療。推薦先口服氟喹諾酮或四環(huán)素等類抗生素2~4周，然后依據(jù)其療效反饋決定是否繼續(xù)