內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-Infection

UrinaryTractInfection

(UTI)

UrinaryTractInfection

(UGeneralremarks

Inthischapter,UTIresultingfrombacterialinvasionisdiscussed.Anatomically.

Itisdividedintouppertracturinaryinfection(pyelonephritis)andlowertracturinaryinfection(cystitis)incidence：UTIisacommondisease(2%inpopulation),particularlyinfemaleadults(10%).GeneralremarksInthischapte內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-InfectionEtiologyandpathogenesis

Pathogen：

gram-negativebacteria（Specificallycoliformbacteria,proteusbacteria）Pyocyanicinfectionisfrequentlyseeninpatientswithinstrumentation.Proteusbacteriaisoftenseeninpatientswithcalculus.EtiologyandpathogenesisPathBacterialvirulencefactorsAhighdegreeofbacterialadherence,whichismediatedbythebacterialfimbriae.Somebacteriacanproducehemolysinwhichcanresistthebody’sdefensesystem.DrugresistancestrainsBacterialvirulencefactors內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-InfectionHostdefensemechanismsEfficientemptyingofthebladderwithvoiding.Aprotectiveglycosaminoglycanlayer.ThehighosmolalityandextremesofpH.IgG,IgAandorganicacidsecretedbyurinarytractmucosa.HostdefensemechanismsHostsusceptibilityfactorsurinarytractObstructionsuchascalculus,vesicoureteralrefluxorintrarenalreflux.

(thepresenceofUTIwithstructurallyorfunctionallyabnormalurinarytractiscalledcomplicatedUTI)ThedeformityofurinarysystemInstrumentationoftheurinarytractHostdefensesystemgetweak,forinstance,diabetesmellitusPregnancy,genderneurogenic

bladderGenetic

factorHostsusceptibilityfactorsInfectionrouteTheascendingroute:periurethraltissues→urethra→bladder→ureter→renalpelvis→renalmedullaThehematogenousrouteLymphogenousspreadDirectextensionfromotherorgansmayoccurInfectionrouteTheascendingr內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-Infection內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-InfectionClinicalmanifestationcystitisIrritativevoidingsymptomsfrequency,urgency,dysuria(burningordiscomfortonurination),suprapubicdiscomfortUrinalysispyuria,bacteriuria,hematuriaBloodtest:generallynormal

ClinicalmanifestationcystitisAcutepyelonephritis

Irritativevoidingsymptoms,flankpain.Systemictoxicityfever,shakingchills,nausea,vomitingSigntendernessofureterspotonpalpation,exquisitetendernessonpercussionofthecostovertebralangle.LaboratoryfindingsBloodtest:leukocytosisandaleftshit.Urinalysis:pyuria,bacteriuria,hematuria.Bloodculture:maybepositive.Acutepyelonephritis

Asymptomaticbacteriuria

nosymptomispresent,yetbacteriuriaexists.內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-InfectionLaboratoryfindings

Urinalysisafindingof≥5WBC/Hpor≥8000WBC/ml↓UTIwhitecellcasts→pyelonephritis.hematuria,proteinuriaLaboratoryfindingsLaboratoryfindingsDetectionofbacteriuriaCollectionofurinesample:Theurineiscollectedinmidstreambeforedrugisusedoratleast7daysafterdrugadministration.Avoidingcontamination,beingsenttothelaboratorywithin1h.LaboratoryfindingsDetectiono

UrinecultureCFUs≥105/ml→significantbacteriuria.CFUsbetween104~105/ml→suspectedUTI→reexaminationCFUs＜104/ml→maybecontamination

(Qualitative

urineculture:iftheurineforcultureisfromcystpuncture,thenwhenpositive,itindicateatrueUTI)Urineculture內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-Infection

Urinesmearexaminedbymicroscopy

when≥1bacteriuria/oil-immersedHP

Chemicaltestforbacteriuria

Nitratereductiontest

thetestisdependentonthebacterialreductionofnitrateintheurinetonitrite.itiseffectiveinidentifyinginfectionduetogram-negativebacteria.UrinesmearexaminedbymicrImaging

IndicationAllmalepatientsFemalepatientrecurrentUTIcomplicatedUTIdisappointingresponsetoantimicrobialtherapy4.everinfectedduringpregnancyImagingIndicationImagingstudiesincludeUltrasonographyIntravenouspyelogram(IVP)Computedtomography

Notice

IVPshouldnotbedoneintheacutephaseofUTI.ImagingstudiesincludeDiagnosisOFUTIsignificantbacteriuriaApositiveresultofurinecultureinwhichurinespecimenisfromcystpuncture.Quantitativeurineculture:apatientbeingsymptomatic,CFUs≥105/mlforonce.apatientbeingasymptomatic,CFUs≥105/mlfortwice(itshouldbethesamespecies)

DiagnosisOFUTIsignificantbaDiagnosisOFUTIwhenafemalepatientwithirritativevoidingsymptomandCFUs≥102/ml,UTIshouldbeconsideredandtreatmentforUTIshouldbegiven.

DiagnosisOFUTIwhenafemaleInfection-localizingdiagnosisurinecultureafterbladderwashouttheassayforantibody-coatedbacteria（ACB)urinaryconcentratingability,urineβ2-MG，urinewhitecellcast.Infection-localizingdiagnosis

bilateralureteralcatheterrization.

itistooinvasiveforgeneraluse.clinicalpractice1.acutepyelonephritisfever(T＞38℃),shakingchills,backpain,WBC↑tendernessonpercussionofthecostovertebralangle2.3daysofantibioticstreatment,ifbeingcured→cystitis,ifnot→pyelonephritis.bilateralureteralcatheterChronicpyelonephritis：

thecorticalscarringacorrespondingcalicealdeformitytubuledamageandinterstitial

inflammationandscarring

內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-InfectionDifferentialdiagnosis

1.renaltuberculosis

aprominentirritativevoidingsymptomnullitytocommonantibioticsmycobacteriuminurinePPD（+）stricture,cavities,calcificationinIVPDifferentialdiagnosis1.內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-Infection內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-Infection內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-Infection內(nèi)科學(xué)教學(xué)課件：Urinary-Tract-Infection2.urethralsyndrome:

exhibitirritativevoidingsymptomnosignificantbacteriuriaInfectiveurethralsyndrome:

causedbyotherpathogenssuchasvirus,mycoplasms,chlamydia.Urinalysisshowpyuria.

Non-Infectiveurethralsyndrome:noWBCisseenwithurinalysis.Probablyitisbecauseofpsychologicalproblems.2.urethralsyndrome:treatmentAntibiotics

G—Bacillus（sulfonamide,quinolones,β-lactamdrugsemisytheticpenicillins,cephalosporins）Afterthedrugsensitivitytestforoffendingorganismsisavailable,thenantibioticsaregivenaccordingtothetest.

treatmentAntibioticsAcutecystitis:singledosetherapyanda3-daycourseoftherapy

↓followeduptoseewhethertheinfectioniscontrolledornotitshouldnotbeusedinpatientswithpregnancy,complicatedinfection,suspectedpyelonephritisormalepatientsAcutecystitis:singledosethe

Acutepyelonephritis

intensiveantimicrobialtherapyshouldbeadministrated.antibioticsfor14daysorally.noeffectwithin72h→adjustthetreatment.

Moderateacutepyelonephritis:intravenoustherapyofantibiotics↓defervescesfor72horalagentatleast14days

Acutepyelonephritis

intensiv

Acutepyelonephritis

Severeacutepyelonephritis:

acombinationofantibioticsaregivenintravenously,oftenanaminoglycosidecombinedwithaβ-lactamdrugorcephalosporins.Acutepyelonephritis

Severea

TherapyforrecurrentUTI：Relapsinginfection：

infectionoccurwithin6wofthecessationofantimicrobialtherapyandiscausedbythesameorganism.Reinfection：

causedbyanorganismwhichisdifferentfromtheoriginalone.TherapyforrecurrentUTI：Re

TherapyforrecurrentUTI：

receiveshortcoursetherapyof7days→followedup7daysaftercessationoftherapy.Ifnosymptom，bacteriuriaandpyuria→curereinfection；Stillwithsymptoms,bacteriuriaandpyuria→treataccordingtodrugsensitivitytest.IfsucceededReinfection,iffailed→abigdoseantimicrobialsfor6weeks.patientswithmorethan3UTIs/years→longtermprophylaxistherapy.TherapyforrecurrentUTI：rtreatmenturinarytractinfectioninpregnancychoosedrugsthataresafetofetus(ampicillincephalexin)asymptomaticbacteriuriaWomeninpregnancy,childrenbeforeschool-age,previoussymptomaticUTI,withcomplicatedfactors---shouldreceivetreatment.treatmenturinarytractinfectiComplication

Acuterenalpapillarynecrosis：accompaniedbydiabetesorurinarytractobstruction.leadtosepsisorARF.presentwithhighfever,severebackpain,hematuria,andureterobstructiontreatment:strengthenantimi